Table of Contents

Welcome Message & Organisation ...... 3

Committees ...... 4

Local Symposium: Mental health in New York City: policy and intervention meet public health ...... 5

Plenary Sessions Presentations: ...... 7

INTRODUCTORY PLENARY TO THE CONFERENCE: Challenges for psychiatric epidemiology in addressing 21st Century mental health challenges with 21st Century methods ...... 7 PLENARY SESSION 1: Social Determinants: What do we do with them? ...... 8 PLENARY SESSION 2: A public health approach to the prevention of psychosis ...... 8 PLENARY SESSION 3: Psychiatric epidemiology and mental health challenges in Mexico ...... 8 PLENARY SESSION 4: Challenges in designing neuropsychiatric genetic research in Africa: Lessons from the NeuroGAP Moi project...... 9

Symposia Presentations: ...... 10

SYMPOSIUM 1: Variation in incidence of psychiatric disorders over time and place ...... 10

SYMPOSIUM 2: Sixty years after WHO meetings on psychiatric epidemiology: Perspectives of impact...... 11

SYMPOSIUM 3: Interventions in a global mental health setting: Successes and challenges ...... 13

SYMPOSIUM 4: Translation and back translation of basic and clinical research to public health ...... 15

SYMPOSIUM 5: Causality and psychopathology: Novel study design, measurement and methods for causal inference ...... 16

SYMPOSIUM 6: Trauma and mental health in a global setting: Research on refugees and displaced persons around the globe ...... 18

Oral Presentations: ...... 19

ORAL PRESENTATIONS SESSION 1: Substance use, adverse childhood events, and externalizing disorders across the life course ...... 19

ORAL PRESENTATIONS SESSION 2: Suicidality, depression and anxiety: understanding etiology and health consequences from womb to adulthood ...... 22

Poster Presentations (PP01-PP76): ...... 25

Book of Abstracts 2

Welcome Message Emerging mental health challenges across the globe

The science of understanding etiology, prevention, and treatment of psychiatric disorders has always had to contend with changing prevalence, new information and technology, novel risk factors, and many other facets of our science that make studying disorders and their consequences a moving target. In the past decade, we have witnessed a changing landscape of many important outcomes across the globe, including the rise of autism diagnoses across many countries as well as suicide, overdose and other injury. Further, these changes are positioned in a political and social landscape that is ever changing, as societies face new and different challenges. The 2018 WPA meeting will present a wide range of novel information regarding psychiatric disorders including the state-of-the-science for novel studies of the biology of illness, global trends in innovative treatment, prevalence, and risk factors. We thank all of you for joining us and welcome you in New York.

The Meeting Co-Chairs,

Elie G. Karam Katherine M. Keyes

Professor and Head Department of Psychiatry Associate Professor of Epidemiology, Columbia and Clinical Psychology, St Georges Hospital University, Mailman School of Public Health, University Medical Center and Balamand New York, USA University Faculty of Medicine, Balamand University, Lebanon

Organization

Organized by: Under the Auspices of:

WPA Epidemiology and Public Health Section World Psychiatric Association (WPA)

Hosted by:

Columbia University Mailman School of Public Health & Columbia University Global Mental Health Program Department of Epidemiology

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Committees

International Committee North American Scientific Committee

Chair: Chair: Elie Karam, Balamand University (Lebanon) Katherine M. Keyes, Columbia University

Members: Members: Rubén Alvarado, Universidad de Chile (Chile) Tracy Afifi, University of Manitoba Laura Andrade, University of Sao Paulo Medical Jim Anthony, Michigan State University School (Brazil) Evelyn Bromet, Stonybrook University Corina Benjet, National Institute of Psychiatry Magdalena Cerda, UC Davis "Ramón de la Fuente Muñiz" (Mexico) Jane Costello, Duke University Terry Brugha, University of Leicester (UK) Sandro Galea, Boston University Linda Cottler, University of Florida (USA) Elie Karam, IDRAAC Rebecca Fuhrer, McGill University (Canada) Viviane Kovess-Masfety, EHESP School for Public Oye Gureje, University of Ibadan (Nigeria) Health (France) Norito Kawakami, The University of Tokyo, Bunkyō- Silvia Martins, Columbia University ku (Japan) Kathleen Merikangas, NIMH Viviane Kovess-Masfety, EHESP School for Public William Narrow, University of New Mexico Health (France) Kathy Pike, Columbia University Kathleen Merikangas, NIMH (USA) Ezra Susser, Columbia University George Patton, University of Melbourne (Australia) Milton Wainberg, Columbia University Michael Phillips, Shanghai Jiao Tong University Myrna Weissman, Columbia University School of Medicine (China) Holly Wilcox, Johns Hopkins Ted Reichborn-Kjennerud, Norwegian Institute of Public Health (Norway) Norman Sartorius, Association for the Improvement of Mental Health Programmes (Switzerland) Thomas Schulze, Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich (Germany) Kate Scott, Dunedin School of Medicine - University of Otago (New Zealand) Dan Stein, University of Cape Town (South Africa)

Meeting Organizing Secretariat ERASMUS Conferences Tours & Travel S.A. 1, Kolofontos & Evridikis street, 161 21 Athens, Greece Telephone: +30 210 7414700 | E-mail: [email protected] Website:www.wpaepi2018.org ; www.erasmus.gr

Book of Abstracts 4

LOCAL SYMPOSUIM

Mental health in New York City: Ecstasy users in the New York City Policy and intervention meet public electronic dance music party scene: A high- health risk population for unintentional use of more dangerous drugs

Joseph J. Palamar1, Alberto Salomone2, Charles M. Would firearm-purchase restrictions related Cleland3 to alcohol-impaired driving reduce homicide 1New York University Langone Medical Center, New York, USA; and suicide? An agent-based simulation. 2Centro Regionale Antidoping e di Tossicologia “A. Bertinaria”, Magdalena Cerdá1, Ava Hamilton2, Katherine M. Turin, Italy; 3NYU Rory Meyers College of Nursing, New York, 2 USA Keyes 1 2 University of California, Davis, California, USA; Columbia Background: Ecstasy (MDMA) use has been prevalent in University, New York, USA the electronic dance music (EDM) scene for decades;

Background: A history of alcohol abuse is as an important however, few studies have investigated use since powder risk factor for interpersonal and self-directed firearm ecstasy, also known as “Molly”, has gained popularity. violence. Yet little information exists on the impact that Ecstasy appears to have become more dangerous in the disqualifying this high-risk group from owning firearms US in recent years due to adulteration with new would have on firearm-related violence. We used an psychoactive substances (NPS). We sought to estimate agent-based model to simulate the change in firearm- the prevalence of ecstasy use in this high-risk scene and related homicide and suicide that would result from to determine the extent of unknown use of NPS, possibly disqualifying people from owning a firearm if they had through adulterants in ecstasy. been convicted of at least one Driving Under the Influence Methods: Time-space sampling was used to recruit adults (DUI) charge in the past 5 years. (age 18-40) about to enter EDM parties in NYC throughout Methods: We created a population of 260,000 agents the summer of 2016. Attendees (n=1045) were surveyed reflecting a 5% sample of the adult population of New York about past-year use of ecstasy/MDMA/Molly and other City (NYC). Agents were placed into a grid representing drugs. Hair samples were collected from a convenience the size, demographics, and location of NYC sample of those surveyed and samples for past-year neighborhoods. Agents could interact, use alcohol, be ecstasy users (n=90) were analyzed using UHPLC- arrested and convicted for various crimes, purchase or MS/MS for the presence of >100 drugs. Prevalence of illegally obtain firearms, and engage in violence or self- ecstasy use in this scene was estimated, and we harm. The model was based on more than 20 national and determined the extent of unintentional use of NPS and city-level data sources. other drugs, defined as testing positive for a drug after Results: Among the general population, disqualification denying use. based on having been convicted for at least one DUI in the Results: We estimate that a quarter (25.1%) of EDM past 5 years reduced firearm-related homicide by 0.89% attendees used ecstasy in the past year. Of past-year (95% CI 0.86-0.93%) and suicide by 4.39% (95% CI 3.51- ecstasy users who were hair-tested, three quarters 5.32). This effect was higher among agents convicted of (74.4%) tested positive for MDMA. However, a third at least one DUI: in this group, disqualification reduced (33.3%) tested positive for an NPS, and 27.8% tested firearm-related homicide by 21.38% (95% CI 19.80- positive for synthetic cathinones (e.g., methylone, 23.90%) and suicide by 8.50% (95% CI 4.45-42.86%). butylone, ethylone, pentylone, alpha-PVP). Half (51.1%) Conclusions: Disqualifications based on indicators of of users tested positive for a drug not reportedly used, with alcohol abuse such as DUI convictions would produce a most testing positive for synthetic cathinones (72.0%) or substantial reduction in firearm-related homicide and methamphetamine (69.0%). Frequent EDM party suicide, particularly among populations experiencing attendance increased risk for testing positive for synthetic alcohol abuse problems. cathinones and other NPS. Conclusions: Many ecstasy users in the EDM party scene are unintentionally using NPS or other drugs.

Book of Abstracts 5

Results should inform prevention and harm reduction in Learning Objectives: At the conclusion of this this high-risk scene. symposium, learners will be able to: Identify four socio-cultural factors that contribute to racial Partnering with African American churches disparities in mental health care. to increase access to care Describe essential elements of a faith-based, community engagement initiative in under-resourced communities. Sidney Hankerson Funding: This work was funded by the National Institute Department of Clinical Psychiatry, Columbia University Medical of Mental Health (K23 MH102540); the Columbia Center, New York, USA University Zuckerman Mind, Brain, and Behavior Institute;

Background: African Americans access mental health the New York State Office of Mental Health Policy Scholar care significantly less than their Caucasian counterparts. Award (Hankerson). Dr. Hankerson has no conflicts of Factors that contribute to this disparity include a general interest to disclose. distrust of providers, limited access, stigma, and a References: Hankerson SH, Lee Y, Brawley DK, Braswell K, Wickramaratne preference for spiritually informed care. According to the P, Weissman MM. Screening for Depression in African Pew Foundation’s Religious Landscape Study (2014), American Churches. American Journal of Preventive Medicine. African Americans have the highest level of religious 2015 Oct; 49(4):526-33. service attendance in the U.S. Thus, exploring how to Hankerson, SH, Suite, D, & Bailey, RK. (2015). Treatment expand access to mental health services through disparities among African American men with depression: partnerships with faith-based organizations appears to be implications for clinical practice. Journal of Health Care for the a promising approach to promote mental health equity and Poor and Underserved, 26(1), 21-34. integrate cultural preferences. Aims/Objectives/Issues of Focus: The aims of my talk Mental health needs of Asian Americans in are to review how a community-based participatory New York City approach was used to address racial mental health Sumie Okazaki disparities within African American churches in New York Department of Applied Psychology at New York University City. Steinhardt School of Culture, Education, and Human Methods/Proposition: I published the first-ever Development, New York, USA depression screening study with a validated instrument (Patient Health Questionnaire [PHQ-9]) in three African- According to the Census estimates, there are now 1.3 American churches in New York City. We conducted focus million Asian Americans residing in New York City, groups with clergy and community members to explore the comprising 15% of the city population. There are many feasibility and acceptability of providing church-based centers of vibrant ethnic community life across the five mental health services. We implemented Mental Health boroughs, with a heavy concentration in Queens and First Aid, an evidence-based health literacy intervention, Brooklyn neighborhoods. It is also a largely immigrant in African American churches in Harlem. population, with three-fourths of Asian New Yorkers being Results/Potential Outcomes: Rates of positive immigrants and nearly 80% speaking language other than depression screen (PHQ9 ≥ 10) were 19.7%. We English at home. Importantly, a sizable segment of Asian successfully created an inter-disciplinary Community Americans in the city live under the poverty line, which Coalition for Mental Health whose mission is to encourage have ranged from 23 to 28% of the population (compared help seeking for mental health problems among people in to the citywide average of 19.9%). These demographic Harlem, with a specific focus on people of African descent factors combine to produce a portrait of mental health in faith-based settings. We have trained 224 African needs that are unmet by existing services. This talk will American clergy and community members in Mental review what is known about the current mental health Health First Aid. status of Asian Americans in NYC based on a recent Discussion/Implications: Taken together, these findings survey of service providers and key stakeholders from suggest that there is good reason to harness the potential various Asian-led and Asian-serving community healing power of religiosity in mental illness. We advocate organizations conducted by the NY Coalition of Asian for the continued development, implementation, and American Mental Health and the Asian American evaluation of mental health programming in religious Federation, as well as a study of service providers serving congregations, with a particular focus on African Asian American children in the city. The service providers Americans and communities with limited access to acknowledged various sources of stresses that place traditional mental health services. immigrant Asian Americans at risk for mental health

Book of Abstracts 6

problems, such as racism and immigration-related stress, public health responses, including naloxone distribution, parenting and family conflicts related to immigration and rapid assessment and response, expanding access to family separation, structural stressors such as crowded effective treatment, instituting post-nonfatal overdose housing, financial strain, and legal or documentation responses, and public awareness campaigns. problems. Across all studies, the service providers articulated multiple challenges facing the local Asian American population, including an inadequate number of linguistically and culturally competent clinician who can provide mental health services to this diverse population, barriers to accessing mental health resources, and invisibility with regard to their unmet needs at the city level. The talk will highlight areas of greatest need for research, practice, and policy.

The opioid overdose epidemic and public health responses Hillary Kunins New York City Department of Health and Mental Hygiene, New York, USA

The lecture is focusing on the epidemiology of the opioid epidemic in the United States, the differences and similarities to the epidemic in New York City, and the key

PLENARY SESSIONS PRESENTATIONS

INTRODUCTORY PLENARY TO THE representative sampling; Third, the associated shift from probability surveys using interviewer-based data CONFERENCE: collection to non-probability surveys using inexpensive web-based data collection (What will happen to data Challenges for psychiatric epidemiology in quality?); Fourth, the shift in focus from primary to addressing 21st Century mental health secondary analysis and meta-analysis (Where will st political support come from for primary data collection?). challenges with 21 Century methods The promising responses to be discussed will include: Ronald Kessler methodological research on data collection quality McNeil Family Professor of Health Care Policy, Harvard improvements using new technologies; mixed-mode Medical School, Boston, Massachusetts, USA epidemiological surveys (e.g., SAQ/interviewer- administered/IVR/performance-based data Psychiatric epidemiology is at risk of even further collection/passive sensors); omnibus surveys; marginalization in the coming years than it experiences collaborative multi-site community epidemiological currently as a result of several trends in biomedical studies; institutional surveys linked to pragmatic trials; research. These trends and some suggested promising and prospective clinical epidemiological studies responses to them will be discussed in this presentation. (including citizen-scientist panels). The four trends to be discussed will include: First, the increasing costs and decreasing response rates of community epidemiological surveys (Where will financial support come from for continued primary data collection?); Second, the increasing focus on biomarkers and, with it, a reduced appreciation of the importance of

Book of Abstracts 7

PLENARY SESSION 1: Results: The identified risk factors for psychosis were the polygenic risk score for schizophrenia, childhood

abuse, living in a city, being from an ethnic minority, drug Social Determinants: What do we do with abuse, adverse life events. The GAP study showed that them? the polygenic risk score accounted for the greatest Joanna Maselko variance in caseness; those with scores in the highest Dept of Epidemiology, Gillings School of Global Public Health, quintile were 7 times more likely to be a psychotic case University of North Carolina at Chapel Hill, North Carolina, than those in those lowest quintile. The GAP study also USA gave estimates of the population attributable fraction (PAF): these indicated that if no one was exposed to The importance of social determinants in mental health child abuse and use of high potency cannabis, then 16% has been acknowledged. We know that factors such as and 24% respectively of psychosis in South London poverty, gender inequality, or education impact the both could be prevented. The EU-GEI study showed striking risk of developing a neuropsychiatric disorder as well as differences in the incidence of psychosis between the likelihood of receiving effective treatment. Beyond Northern and Southern Europe; data will be prevented that, it is easy to feel disheartened: We are not well concerning the contribution of risk factors to this. equipped to get rid of poverty or equalize gender Conclusions: The knowledge that schizophrenia is the relationships. In this talk I will discuss what we, as extreme of a continuum of psychosis has important epidemiologists, clinicians and public health practitioners implications for prevention. Preventive approaches to can do to reduce the negative impact of some social hypertension or obesity do not focus on identifying factors on the populations we work with, while generating individuals carrying biological markers; rather they knowledge that will help further our understanding of how encourage members of the general population to take to reduce social inequities in mental health. exercise and reduce their calorie intake. A similar approach should be adopted for psychosis. Clearly, PLENARY SESSION 2: reducing some of these (e.g. the polygenic risk factor for psychosis) is not within the powers of psychiatrists However, attempts to reduce other risk factors should be A public health approach to the prevention made e.g. addressing psychotogenic aspects of city of psychosis living or by decreasing discrimination against ethnic Robin M Murray, Marta Di Forti, Evangelos minorities. This will be difficult. However, an obvious Vassos, Harriet Quicgley, Antonella Trotta, Diego place to start is by attempting to influence society’s Quattrone, Victoria Rodrigues, Craig Morgan patterns of consumption of high-potency cannabis. Institute of Psychiatry, Psychology and Neuroscience, King’s Unfortunately, public policy in the US and certain other College, London, UK countries appears to be moving in the opposite direction with increases in consumption and potency. Are these Background: The main attempt to prevent the countries sleep-walking to more psychosis? development of psychosis has been through prodromal clinics for people at clinical high risk. Such an approach is useful for research but can never reach the majority of PLENARY SESSION 3: individuals who will become psychotic. Biological markers could be used to identify individuals with Psychiatric epidemiology and mental unusual vulnerabilities e.g. those with copy number health challenges in Mexico variations such as VCFS. However, identifying the Corina Benjet individuals with such markers is unlikely to impact on the Department of Epidemiological and Psychosocial Research, majority of cases, and as yet no useful interventions are National Institute of Psychiatry; School of Psychology and available. How therefore to prevent psychosis? Medical School, National Autonomous University of Mexico, Methods: Data will be presented from 3 studies of first Mexico City, Mexico onset psychosis (FEP) which used similar methods of ascertainment and assessment of cases and controls; While the overall prevalence of psychiatric disorders in AESOP and GAP from South London and the EU-GEI Mexico is comparable to other countries from the World across 16 sites in 5 European countries. These studies Mental Health Surveys Consortium, Mexico has a sought to elucidate risk factors for psychosis. greater proportion of severe cases, likely due to a small proportion making treatment contact and longer

Book of Abstracts 8

treatment delays among those that do. Psychiatric will continue to increase. Quality psychiatric disorders are treated more in specialized care rather epidemiology research can help guide (and pressure than primary care. The greater prevalence of mental policy makers) to tackle important challenges such as disorders, substance use and suicidal behaviors among the limited proportion of the health budget spent on younger generations, an important increase in violence mental health, the large proportion of mental health in the country (e.g., kidnappings, homicides, feminicides, spending on psychiatric hospitals rather than community and organized crime) and the potential for large scale services, the inequities in the distribution of mental return migration, suggest that mental health challenges health services, the lack of access to basic pharmacological and evidence-based psychological make designing a similar study in other African settings treatments, stigma towards psychiatric illness, and the more efficient. lack of national policies or programmes for mental health Background: While it is an accepted fact that severe prevention and intervention. Cultural strengths that are mental disorders such as schizophrenia and other protective factors need to be leveraged in new modalities psychotic illnesses have multifactorial aetiology that of prevention and treatment at the community level. includes an individual’s genetic makeup, comparatively Some of this is beginning to take place in the research little work has been done towards identifying the specific context. This presentation will discuss the history of genetic factors that increase the risk of these disorders. psychiatric epidemiology research in Mexico, what the In recent years some efforts have been made to findings of this research has taught us about mental generate information on the genetics of mental disorders health challenges in Mexico and how these findings have and exciting results are beginning to be seen. However, informed and can continue to inform public health policy most of the data in this area comes from populations that in Mexico. are predominantly Caucasian, and it is therefore difficult to determine the applicability of these findings globally. African populations are particularly under-represented PLENARY SESSION 4: despite the fact that they represent the most diverse genetic pool in the world, and it is perhaps from this pool Challenges in designing neuropsychiatric that confirmatory findings on the genetic antecedents of genetic research in Africa: Lessons from mental disorders will emanate. Method: This presentation examines the development of the NeuroGAP Moi project a research project whose objective is to characterise the Lukoye Atwoli1,2,3, Edith Kwobah1,2,3, Gabriel genetic associations of psychotic disorders among Kigen4, Wilfred Emonyi5, Stella Gichuru1, Dan Africans. The project, named Neuropsychiatric Genetics Stein2, Karestan Koenen6 of African Populations (NeuroGAP), is a collaborative 1Department of Mental Health, Moi University School of effort between the Harvard T.H. Chan School of Public Medicine, Eldoret, Kenya; 2Department of Psychiatry and Health and universities across the African continent- Mental Health, University of Cape Town, South Africa; 3Mental South Africa, Ethiopia, Uganda, and Kenya. We describe Health Unit, Moi Teaching and Referral Hospital, Eldoret, the challenges encountered in designing this project in Kenya; 4Department of Pharmacology and Toxicology, Moi the western Kenyan arm of the multicentre collaborative University School of Medicine, Eldoret, Kenya; 5Department of Immunology, Moi University School of Medicine, Eldoret, project, at Moi University’s School of Medicine in Kenya. Kenya; 6Department of Epidemiology, Harvard T. H. Chan Outcome: We shall present a summary of the study School of Public Health, Boston, USA implementation so far and identify solutions that would make designing a similar study in other African settings Outcome: We shall present a summary of the study more efficient. implementation so far and identify solutions that would

Book of Abstracts 9

SYMPOSIA PRESENTATIONS

SYMPOSIUM 1: Variation in standardised developmental history assessments conducted through informants. incidence of psychiatric disorders Findings: Findings will be reported including a over time and place comparison of the 2007 and 2014 rates, the overall rate combining the able and intellectually disabled populations, and associations between prevalence and age across the Is there an autism epidemic? The distinction entire adult age range. Other associations will be between passive and active ascertainment described that a population survey approach can provide Traolach Brugha1, Sally McManus2, John Bankart1, in contrast to surveillance approaches. Freya Tyrer1, Sally Ann Cooper3, Nicola Spiers1, Discussion: The discussion will focus on the relative Abdulreza Kiani1, Rachel Jenkins4 merits of the passive and active approaches to sampling 1University of Leicester, Leicester, United Kingdom; 2NatCen design and the scientific, public health and clinical Social Surveys, London, United Kingdom; 3University of implications for future work on the lifecourse epidemiology Glasgow, Glasgow, United Kingdom; 4Institute of Psychiatry of autism. Psychology and Neurosciences, London, United Kingdom References: Brugha TS, McManus S, Bankart J et al. Epidemiology of autism spectrum disorders in adults in the Background: Number of persons (in childhood) with community in England. Arch Gen Psychiatry. autism until recently was reported to be increasing. Such 2011;68:459-465. reports rarely involve an intelligible, in depth examination Brugha TS, Spiers N, Bankart J et al. Epidemiology of of the effect of variations in method. Two explanations for autism in adults across age groups and ability levels. Br J any such rise may boil down to increases in recognition Psychiatry. 2016, Dec;209(6):498-503. and reporting versus a true trend in the population McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (exemplifying fake news versus fact reportage?) Two (2016) Mental health and wellbeing in England: Adult substantive bodies of research may help cast light on this. Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. A series of studies of education and health records of young children across different counties and states of the USA conducted by the Centers for Disease Control and Comparing children mental health across Prevention (CDC), Atlanta, based on a disease countries: Challenges and results surveillance, passive sampling method, will be Viviane Kovess- Masfety summarised briefly, because the CDC work has been EHESP School for Public Health, Paris, France widely interpreted in the media as attesting to the autism epidemic proposition. Findings of three independent The School Children Mental Health Europe was an EU general population surveys using active sampling funded project designed to set up a kit of instruments methods across the entire adult age range in England will enabling cross EU comparisons. A literature review allows then be presented in contrast to the CDC work. to select the SDQ (Strengths and Difficulties Methods: The Adult Psychiatric Morbidity Survey (APMS) questionnaire) to be administered to the parents and programme has conducted probability samples of adults teachers and the Dominic Interactive, a sort of video game from age 16 upwards, seven yearly since 1993. Autism designed to evaluate DSM more commune diagnoses was added to the programme in 2007 (Brugha et al 2011) since the children were primary school children 6 to 11 and 2014. Because these community surveys actively years old. Previously done in France, the project has sample verbally competent adults, only, a third survey collected around 1000 children per country in Germany, using active sampling from adult intellectual disability Italy, Netherlands, Lithuania, Bulgaria, Romania and registers was also completed, designed to enable Turkey. In addition, it measured parental attitudes, amalgamation of prevalence estimates. The domestic accidents, some physical diseases, parental developmentally appropriate version of the Autism mental health, school achievements, access to care for Diagnostic Observation Schedule (ADOS) acted as the mental health problems and some socio demographics. It case definition measure, which was cross validated in the allows exploring in depth the instruments contents across able and intellectually disabled samples using countries as their relative concordance on separate

Book of Abstracts 10

clinical samples from each of the countries using the in urban vs. rural centres in northern European countries DAWBA a clinical instrument. The lecture proposes to but not in southern European countries. Further, in present and discuss the comparisons on the main mental analyses of pilot data from INTREPID, we found high rates health dimensions across countries and the challenges for in all sites compared with previous studies in developing interpreting the differences. It will also describe how such countries. Understanding these variations may provide cross comparisons could participate at the evaluation of novel insights into the nature and aetiology of psychoses. diverse policies such as tobacco banning, physical corporal punishment regulations, car accident prevention What is causing the substantial cross- or mental health services provision for children. I will conclude on the possibilities to extend this approach in national drop in suicide mortality? different countries and different situations such as Michael Phillips developing countries as countries under conflicts. Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China Heterogeneity in psychoses: A global perspective The absolute number and age-standardized rate of suicide Craig Morgan1, Hannah Jongsma2, Charlotte Gayer- have dropped substantially in most, but not all, countries Anderson1, Robin Murray1, Bart Rutten3, Jim van Os4, over the last two to three decades, much faster than the James Kirkbride5, Peter Jones2, Alex Cohen6, Gerard drop in the rate of death by most other causes. There are huge differences in the rate and demographic pattern of Hutchinson7, Rangaswamy Thara8, Oye Gureje9, EU- suicide deaths between countries, and between regions GEI Work Package 2 study team, INTREPID study within countries, but with a few notable exceptions the team rates of suicide in both genders and in most age groups 1Institute of Psychiatry, Psychology, and Neuroscience, King’s have all dropped steadily over this period. Surprisingly, 2 College London, London, UK; University of Cambridge, these changes have not been associated with Cambridge, UK; 3Maastricht University, Maastricht, The Netherlands; 4Utrecht University, Utrecht, The Netherlands; corresponding changes in the prevalence and burden of 5University College London, London, UK; 6London School of depression, alcohol use disorders, or other mental health Hygiene and Tropical Medicine. London, UK; 7University of the conditions that are considered the most important risk West Indies, Jamaica; 8Schizophrenia Research Foundation, factors for suicide. So, the reasons for these major Chennai, India; 9University of Ibadan, Ibadan, Nigeria changes in the rate, demographic pattern and global distribution of suicides remain unclear. Moreover, despite There is substantial evidence that the incidence, the declining trends, the most recent projections from the presentation, and outcome of psychoses vary across Global Burden of Disease study indicate that only 18 of the space and by social group. For example, there is evidence 188 countries assessed will achieve the goal of the WHO that rates of psychotic disorder differ by population density Global Mental Health Plan to decrease suicide death rates and that rates and outcomes vary by minority ethnic group. from 2015 to 2020 by 10% and only four countries will However, much of this evidence comes from studies in a achieve the UN's Sustainable Development Goals (SDG) select number of northern European countries and it target of reducing suicide rates by one-third between 2015 remains unclear whether these patterns are generalisable and 2030. to more diverse settings. Broadening our perspective to investigate psychoses in a wider range of contexts promises to deepen our understanding of the SYMPOSIUM 2: Sixty years after heterogeneity in psychotic disorders. In this paper, we WHO meetings on psychiatric present data from two multi-country studies on variations epidemiology: Perspectives of in psychoses: the EU-GEI study - a 6 country, 16 centre incidence and case control study of first episode impact psychosis, and INTREPID - a study in 3 developing countries of the phenomenology, incidence, and course The first 40 years of The World Health and outcome of psychoses. In analyses to date, we have Organization’s mental health programme: a found evidence a) of marked variations in incidence and other aspects of psychotic disorder and b) that these snapshot and the long-term consequences variations do not simply mirror what has been found in Norman Sartorius studies in northern Europe. For example, in our EU-GEI Association for the Improvement of Mental Health Programmes sample of 2,780 cases of psychosis, we found high rates (AMH), Geneva, Switzerland

Book of Abstracts 11

The presentation will give a brief description of the Department of Epidemiology, University of Florida, Gainesville, development of the Mental Health programme of the Florida, USA World Health Organization during its first 40 years of existence. It will describe the main lines of action and the While communicable disease surveillance has been a results of its work which also included the publication of hallmark of public health since the end of the 19thcentury, results of international epidemiological studies and the it was much later when the field began its surveillance of th organization of meetings of experts on various topics non-communicable diseases and not until the mid-20 including the epidemiology of mental illness. This will century for psychiatric disorders. This surveillance, provide a background to the reviews of developments over needed to understand the relative burden to society as the 60 years in three important fields of work of psychiatry well as the need for services, started with a number of - that of schizophrenia and psychotic disorders, that of landmark psychiatric studies around the world. Central to abuse of psychotropic substances and that of changes of the launching of each was, of course, the need for a unified health services for people with mental illness. concept of the symptoms and resultant disorders, a familiarity with nosology and ultimately a diagnostic assessment that operationalized all of these to determine Changing paradigms for schizophrenia the presence of psychiatric conditions and their William T. Carpenter impairment level. This presentation will focus on the cross- Department of Psychiatry, Maryland Psychiatric Research cultural aspects of surveillance, especially as they pertains Center, University of Maryland School of Medicine, Baltimore, to the study of substance abuse/dependence/harmful use. USA We will discuss the tension between primary data The concept of schizophrenia presented over a century collection (almost a lost art) and Big Data approaches. ago by Kraepelin and Bleuler remains influential, but the While there are advantages to “data mining” with large effort to establish schizophrenia as a single disease entity datasets, the hyperlocal cultural issues, environmental with a unifying etiology and pathophysiology has failed. context and the voice of the community may be Approaches to syndrome deconstruction are essential in underrepresented more than ever. This presentation will research and clinical application. Examples include address issues that must be kept in our modern subtypes, symptom dimensions, phenotypes, and surveillance efforts along with evidence-based examples reorganizing the framework of psychopathology (HiTOP). from around the world focused on: principles of community New paradigms for research include the SyNoPsis, the engagement, assessment of the social determinants of Research Domains Criteria (the NIMH RDoC initiative), health, dissemination of findings, integrating special and the study of mechanisms by defining specific aspects populations, collaboration with clinical and translational of psychopathology in clinical and basic science science colleagues, and workforce development. A laboratories. Concepts of therapeutic targets are shifting Precision Public Health model will be used to show how from disease category to specific clinical indication multiple datasets can be combined for surveillance, considered across diagnoses. Personalized medicine is treatment need, and ultimately intervention development. dependent on individual differences within syndromes. An ethics moment related to surveillance of psychiatric Large scale epidemiology is challenged to move from the conditions will be addressed, spurred by the WHO syndrome level (e.g., where schizophrenia is the Guidelines on Ethical Issues in Public Health phenotype for GWAS studies with weak results) to the Surveillance. level of specific psychopathology. While disorder categories are still meaningful and necessary in nosology, Epidemiology links to nosology and mental component psychopathology viewed across categories is health policy: Historic perspective essential for robust psychiatric epidemiology. Darrel Regier Epidemiology of risk factors for psychopathology and Department of Psychiatry, Uniformed Services University, concepts for primary prevention can be viewed through Bethesda, Maryland, USA the lens of deconstruction. Following World War II, there was a renewed interest in Precision public health: A method for the degree to which environmental exposures were disease surveillance and intervention related to the etiology and prevalence of mental disorders. These exposures included combat stress as well as the development in psychiatric epidemiologic environmental conditions that resulted in a high number of research volunteers being excluded from military service based on Linda Cottler mental health screening instrument results- including the

Book of Abstracts 12

Army’s Neuropsychiatric Screening Adjunct (NSA) (Srole ‘Der Biaber ambessa yasser,’ transliterated from Amharic, p. 42). Social psychiatrists and epidemiologists including is a proverb that means together we can lasso a lion, Leighton, Srole, Pasamanick, and Dohrenwend in the U.S. evoking the metaphor of overcoming threat through a used variants of the military screening instrument as a unified effort – in this case, it is referring to the lion of case finding tool to identify people with symptoms of under-treated, stigmatized mental illness. In Ethiopia there mental illness and associated disability (“strains”), that are now 80 psychiatrists and about 200 Masters level could be correlated with socio-economic stressors. mental health workers – for 100 million people. The Biaber Without clear diagnostic criteria, it wasn’t possible to Project (PIs: Wondimagegn & Pain), funded by Grand assess the prevalence of specific mental disorders in large Challenges Canada, which ended in 2017 sought to populations where clinicians could not make direct integrate mental health services into primary health care diagnoses. Wide variations also existed across national in Ethiopia. Canadian and Ethiopian psychiatrists boundaries on the criteria used for diagnosing such central developed training materials for local mental health psychiatric conditions as schizophrenia and manic- workers in Addis Ababa, who taught general nurses and depressive psychotic illnesses (Wing J et al.). health officers working in primary care health centers. With the advent of the DSM-III in 1980, more specific These health workers, who had no previous formal diagnostic criteria, screening instruments, and clinical exposure to Western mental health ideas were taught to assessment instruments became available for case- screen and treat patients’ positive for common mental finding in large epidemiological studies (Regier DA et al., disorders using culturally adapted IPT for Ethiopians (IPT- 1984). The Epidemiological Catchment Area (ECA) study E). Over 4 years, 27,000 Ethiopians in primary health was the first to use such criteria to link mental health settings were screened and 13% (2000) of these patients epidemiology to ongoing biological, nosological, genetic, were treated with IPT-E. We adapted IPT to the context familial, mental health service use, and clinical research and conditions of Ethiopians. We found IPT-E a model that on mental disorders (Freedman DX, 1984). This link had was easily accepted by both trainers and patients in profound national and international health policy primary care settings, and had high rates of satisfaction. implications. These changes were facilitated by the IPT is an evidence-supported, potentially scalable adoption of the DSM-III explicit diagnostic criteria treatment for numerous psychiatric disorders, especially approach for the WHO’s 10th edition of the International depression across the lifespan that has been used in Classification of Diseases (ICD-10), and the development numerous trials and humanitarian projects in LMIC of the DIS, CIDI, SCAN, and SCID diagnostic interviews settings. The therapeutic focus of IPT, on relationships for epidemiological, mental health services, and clinical and interpersonal stressors of social role transitions, role research. disputes, and grief, resonates with universal human This presentation will focus on the impact of these experiences of suffering and the central role of changes on mental health policy issues including mental relationships in health and well-being. With a strong body health parity legislation, integrated treatment with primary of research supporting it as an efficacious mental health care clinicians, public education destigmatization treatment, IPT is included in the World Health campaigns, mental disorder contributions to the Global Organization’s mhGAP depression guidelines. Improved Burden of Disease, reducing the potential abuse of access to IPT is needed in light of its psychiatry (Soviet Union and China), and quality adaptability, effectiveness, low drop-out rates, and high assessment for treatment reimbursement. levels of patient satisfaction. This presentation will describe the Biaber Project and processes that we used SYMPOSIUM 3: Interventions in a in culturally adapting IPT-E.” global mental health setting: Research to practice partnerships to Successes and challenges decrease the mental health treatment and research gaps Together we can lasso a lion - Adapting and Milton Wainberg integrating IPT into primary health care in Professor of Clinical Psychiatry, Columbia University, New York, USA Ethiopia Paula Ravitz The Global Burden of Disease Study 2010 not only Department of Psychiatry; Psychotherapy, Humanities and corroborated findings from 1990 about the significant Education Scholarship Division for the University of Toronto, burden of mental and substance use disorders, but it also Toronto, Canada

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identified that the burden of these disorders had most interventions were delivered by frontline PHCWs worsened. Mental and substance use disorders are now after training by psychiatrists with ongoing support and the leading cause of years lived with disability globally. supervision provided by primary care physicians as well Lack of human resources, poor to no financing, weak as by psychiatrists mostly through the use of mobile governance, and mental illness illiteracy and stigma all phones. Interventions used in these studies included contribute to the global mental health treatment gap, which psychosocial interventions such as psychoeducation, in comparison to high-income countries is worse in low- activity scheduling, problem solving treatment, and middle-income countries and in low-resource settings reactivation of social network and medications (mainly of high-income countries. The goal to vastly spread amitriptyline). The PHCWs had little difficulty delivering the access to care in low-resource settings requires multiple interventions for patients identified for them by research strategies to increase resources and capacity building to staff using a screening tool. We found that simple implement and scale-up effective interventions for the psychosocial interventions were effective in ameliorating prevention and treatment of mental and substance use depression symptoms and reducing disability. Most of the disorders. In spite of this well-documented global burden patients were effectively managed by the primary care of mental illness, efforts to address the global mental providers with only about 2% requiring specialist health treatment gap have been sparse in comparison to consultations. The common constraints were those of the the well-funded (non-mental health) global health time (20-30 minutes) required for the psychosocial programs. Concerns about the low research to practice intervention sessions and retaining patients in care. Two and policy yield are far worse in the mental health field, major challenges identified in our ongoing implementation even in high-income countries. The global mental health study are that the identification of women with perinatal research and treatment gap requires investing in depression by the PHCW is very low (at about 12%) and implementation science researcher capacity building and that these workers had little motivation to integrate research projects facilitated by participatory approaches depression care into routine maternal care. While primary with policy makers and community stakeholders and care workers can indeed provide effective interventions for practice-based production of research. A successful depression, scalability of a task-shifting/sharing approach partnership between US, Brazil and Mozambique will be requires targeted efforts to improve the identification skills presented as a model to address the global mental health as well as the motivation of the providers to provide research and treatment gap. depression care within an integrated routine primary care.

Interventions for depression delivered by Challenges to improve adolescents’ mental non-physician primary health care workers health in Latin America in Nigeria Vania Martínez Bibilola Oladeji Faculty of Medicine of Universidad de Chile, Santiago, Chile Department of Psychiatry, College of Medicine University of Ibadan, Ibadan, Nigeria There are many factors influencing adolescent mental health – such as increased pressure to succeed, coupled Nigeria, like most other low and middle-income countries with social isolation – and the great prevalence of the (LMIC), has inadequate specialist manpower to provide mental health problems. The majority of mental health mental health care for persons in need. Bridging the disorders have their onset in adolescence. This is an resulting treatment gap requires the integration of mental especially vulnerable time for development, because of health care into primary health care, with the frontline the many positive and negative influences they receive in providers at this level receiving appropriate training as well this part of the life cycle. as on-going support and supervision from the few The positive news is that these issues can be addressed available specialists. Several studies have demonstrated with prevention and early detection and intervention. that with training, non-physician primary health care However, in Latin America, it has been found the health workers (PHCWs) can deliver effective interventions for services currently available do not meet their needs. common mental disorders. Our experience from 2 recently In this context, the challenges are to generate evidence on concluded trials and an on-going implementation study in interventions aimed at improving the mental health of Nigeria provides an opportunity to examine the adolescents and youth with an approach that is: 1) opportunities and challenges of delivering interventions for comprehensive and encourages inter and trans- depression in primary care. These studies adopted a disciplinary dialogue; 2) empirically based; 3) systemic measurement-based, stepped-care approach, where and multilevel 4) intersectoral, which includes

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strengthening the link between educational communities Impact of SeXX on psychiatric disorders: and health and social services; 5) aware of the life cycle; The case for why neuroscience needs and 6) culturally, territorially, and gender aware. Additionally, for this population is useful the use of the epidemiology and vice versa participatory action research designs, as well as the use Jill Goldstein of information and communication technologies (ICTs) in Department of Psychiatry and Medicine, Harvard Medical the interventions. School, Boston, MA, USA; Women, Heart and Brain Global We propose initiatives that focused on: 1) to explore the Initiative, Massachusetts General Hospital, Boston, MA, USA causes and social consequences of mental health problems; 2) to raise awareness and reduce stigma; 3) to There is no larger unmet need in women’s health than promote the development of socio-emotional skills; 4) to tackling the issue of shared pathophysiology, prevent emotional distress, risk behaviors, and epidemiology, and healthcare for the brain and heart. psychopathology; 5) to facilitate and encourage the early Heart disease is the number one killer of women in the detection of psychopathology and timely access to mental U.S., impacting over half of American women and those in health services; 6) to adapt, develop, and evaluate mental most middle-income countries. Recently, W.H.O reported health treatments specifically for this population; and 7) to that major depressive disorder topped ischemic heart contribute to the strengthening of public policies focused disease as the number one cause of disability worldwide, on this group. and women have twice the risk. In fact, the prevalence of As examples, we have implemented interventions: 1) to the comorbidity of depression and cardiovascular disease improve the knowledge of adolescent depression among (CVD) is >20%, is significantly higher in women than men, school staff; 2) to treat depression in adolescents in and when present together results in a 3-to-5-fold risk of primary care clinics; and 3) to prevent depression in school death. Finally, depression, CVD and metabolic syndromes setting. (like obesity and diabetes) are independent risk factors for memory decline and Alzheimer’s disease in later life, also with a 1.5-fold higher frequency in women than men, and SYMPOSIUM 4: Translation and back not simply due to longevity. Thus, understanding the brain- translation of basic and clinical heart connections and how these differ by sex is critical for understanding risks and resilience for maintaining healthy research to public health aging across the lifespan. Our team has been investigating the fetal programming of shared Challenges and opportunities for pathophysiology for understanding sex differences in translational neuroscience for psychiatry depression and CVD risk. We believe that taking a lifespan Joshua Gordon approach, beginning in fetal development, is critical for understanding shared risks and resilience for sex Director, National Institute of Mental Health Bethesda, MD, USA differences in the comorbidity of these illnesses that While much progress has been made in neuroscience of primarily occur in adulthood. Dr. Goldstein will use this relevance to psychiatry, comparatively little progress has work to exemplify why neuroscience needs epidemiology been made in translating neuroscientific understanding and vice versa. There are growing efforts to decrease the into novel treatments. This lecture focuses on the gaps in knowledge about the impact of sex on diseases of challenges and opportunities for translation. Challenges the heart and brain, although they occur independently in include (1) the complexity of the genetic architecture of departmental silos by discipline. We believe that an psychiatric disease, (2) the difficulty of constructing and integrated approach across the lifespan to study brain- validating animal models of psychiatric disorders, and (3) heart connections will accelerate the development of novel the lack of definitive translatable biomarkers, among early interventions that are sex-dependent and more others. Opportunities afforded by recent developments effective in alleviating the burden of disease nationally and may help address these challenges, including (1) the globally. emergence of numerous biological clues coming from genetic and environmental risk factors, (2) increasingly Contributions of genetic epidemiology to sophisticated tools for interrogating neural circuits, (3) the our understanding of mental disorders in availability of novel computational and theoretical tools, (4) the molecular era novel experimental systems, including human cellular Kathleen Merikangas1, Neil Risch2 approaches.

Book of Abstracts 15

1National Institute of Mental Health, Intramural Research Causal effect decomposition in the context Program, Bethesda, Maryland, USA; 2Institute for Human Genetics, University of California at San Francisco, San of time varying exposures and mediators: Francisco, CA, USA An example John Horwood This talk will describe the contributions and challenges of Department of Psychological Medicine, University of Otago, genetic epidemiology in advancing our understanding of Christchurch, New Zealand mental disorders. Recent findings from genome wide association studies (GWAS) of each of the major mental In the past decade the field of causal inference has seen disorders and their core components will be described and a renewed interest in mediation and the development of a summary of aggregate phenotypic risk estimates, and intuitively meaningful indices of direct and indirect causal phenotypic and genotypic heritability based on GWAS will effects. So-called interventional effects provide a useful be summarized. Examples from recent family and twin approach to effect decomposition in the presence of studies of the core components and endophenotypes of mediator-outcome confounding or in the context of mental disorders that may inform future genetic studies multiple correlated mediators. Recently VanderWeele and will be presented. Future opportunities and applications of colleagues have extended this approach to a repeated epidemiology to our understanding of psychiatric disorders measures context involving repeated assessments of in the molecular genetics era will be discussed. a time dynamic risk exposure, mediators and an outcome. This approach makes it possible to derive meaningful The valley of death and evidence-based indices of causal effect decomposition reflecting the accumulative history of exposure to a risk factor over health care; the problem of adolescent repeated assessments. This presentation uses data from depression the Christchurch Health and Development Study (CHDS) Peter Szatmari to illustrate these methods. The CHDS is a longitudinal Child and Youth Mental Health Collaborative, The Hospital for study of a birth cohort of 1265 children born in Sick Children and Centre for Addiction and Mental Health, Christchurch (New Zealand) in 1977 and studied Toronto, OntarioCanada repeatedly over the life course from birth to age 40. The analysis uses repeated measures data gathered at 5- The “valley of death” in biomedical research refers to the yearly intervals through adulthood to explore the causal difficulty in translating research findings into changes in linkages and mediating pathways between the history of a clinical practice and policy. For there to be a fruitful mental disorder (major depression) and a measure of synergy between basic and clinical research in mental adult economic well-being (income). health that successfully “crosses” this valley, there needs to be some agreement on what are the key evidence gaps that must be filled to influence health outcomes to the Common mental disorders in adolescents greatest degree. One of the most important roles played and offspring early life emotional reactivity: by the publication and dissemination of rigorously A causal sequential mediation analysis of a produced Clinical Practice Guidelines (CPGs) is to identify prospective intergenerational study key evidence gaps that must be filled to improve outcomes Elizabeth Spry1,2,3, Craig A. Olsson 2,1,3,4, Denise for a population. However, it will be illustrated, using 1 1,4 adolescent depression as an example, that the Becker , Margarita Moreno-Betancur , George P. 3,1,4 development of CPGs in child and youth mental health are Patton mostly of poor quality and so do not provide clear insight 1Murdoch Children’s Research Institute, Melbourne, Australia; 2 into what research needs to be done so that mental health Centre for Social and Early Emotional Development, Deakin University, Australia; 3Centre for Adolescent Health, Royal outcomes for children and youth can be improved. Children’s Hospital, Melbourne, Australia; 4The University of Melbourne, Melbourne, Australia SYMPOSIUM 5: Causality and Introduction: Parental mental disorder in the perinatal psychopathology: Novel study period is a well-established risk factor for offspring mental design, measurement and methods disorders. These associations may be causal, operating via environmentally-induced epigenetic changes for causal inference postnatally or in utero. Another possibility is that the effects of parental mental disorder on offspring begin well before

Book of Abstracts 16

conception, either via persistence of established risk outcome and an indirect effect operating through a factors into the perinatal period or direct preconception number of possible hypothesized pathways. We provided effects through enduring modifications to gametes. a novel decomposition of the total effect that unifies Preconception exposures remain largely unstudied, mediation and interaction when multiple mediators are however, along with the extent to which these effects are present. Recent work making use of causal mediation transmitted via persistence of problems into pregnancy analysis has provided critical insights for the treatment of and the postpartum period. Here we examine the schizophrenia. However, secondary analyses conducted associations between maternal preconception and in individual trials are likely not sufficiently powered to yield perinatal mental health problems and offspring infant strong conclusions about mediating and interactive emotional reactivity, an early phenotypic marker of mechanism. The current study aims to address the issue vulnerability for later mental disorder, using data from The of missing data, capture the complex underlying Victorian Intergenerational Health Cohort Study (VIHCS). mechanisms of change, and integrate information from Methods: VIHCS is a prospective two-generation study four paliperidone efficacy trials to produce more powerful with repeated assessments of parent mental health, causal mediation analyses. substance use and social context over fifteen years from Method: The statistical analysis of the current study adolescence to adulthood, and during pregnancy, consisted of two main approaches (1) hierarchical linear postpartum, infancy and mid-childhood for 1026 modeling and (2) multivariate meta-analysis. Within the subsequently born offspring. We first examine the frameworks of the two integrative approaches, causal associations between maternal preconception mental mediation analysis was performed to clarify and quantify health problems, and heightened offspring emotional the roles of side effects and positive symptom change in reactivity. We then use causal mediation analysis based explaining the association between treatment and change on interventional effects to examine the role of two in negative symptoms among patients with schizophrenia. sequential mediating processes across the perinatal Results and Conclusions: The present study provides period. Specifically, we examine the role of antenatal and the first application of integrative approaches for causal postnatal maternal mental health problems in the mediation analysis with multiple mediators in the presence association between preconception mental health and of potential effect modification. The inference we drew offspring infant emotional reactivity. based on the results from the two approaches were Results: Offspring heightened emotional reactivity at one similar, demonstrating the reproducibility of our results via year of age was associated with preconception maternal different methods. PANSS positive symptom score was mental health problems in adolescence and young identified as the most important mediator; it explained adulthood (adjusted RR 1.9, 95% CI 1.2-2.9), during the approximately 80% of the treatment effect in the high dose third trimester of pregnancy (aRR 1.7, 95% CI 1.0-2.9), group (12mg/day), approximately 70% in the medium and concurrently at one year of age (aRR 1.8, 95% CI 1.1- dose group (9mg/day), and approximately 50% in the low 3.0), but not at 10 weeks postpartum. Associations dose group (6mg/day). between maternal preconception mental health problems and offspring emotional reactivity were only partially Understanding effectiveness in mediated by ante- and postnatal maternal mental health populations: Bridging internal and external problems. Conclusions: These findings suggest that the origins of validity early vulnerability for later mental disorder do not lie solely Elizabeth Stuart in the perinatal period, but also in processes established Department of Mental Health, Department of Biostatistics, well before this time. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

Integrating information across efficacy Many policy and practice questions involve wanting to trials to gain insights on antipsychotics know about the causal effects of interventions or risk mechanism of action factors in populations. However, while rigorous designs Linda Valeri such as randomized controlled trials provide unbiased Department of Psychiatry, Harvard Medical School, Boston, MA, effect estimates for the sample at hand, they do not USA necessarily inform about effects in a target population of interest — they provide internal validity but not necessarily Background: Mediation analysis allows decomposing a external validity. While there has been increasing total effect into a direct effect of the exposure on the discussion of this limitation of traditional trials, relatively

Book of Abstracts 17

little statistical work has been done developing methods to suicide compared to the general population. Burnout assess or enhance the external validity of randomized trial among health care workers is associated with high results. This talk will provide a framework for thinking turnover rates and absenteeism, and low job satisfaction. about internal and external validity in the context of Burnout has been documented to effect the safety of care population treatment effects and will provide an overview provided by physicians and can result in personal of statistical methods to assess and enhance external relationship problems, substance abuse, depression and validity. Applications in psychiatry and mental health will even suicide. Humanitarian aid workers, across sectors, be included. Implications for how future studies should be are also reported to have high levels of mental ill health, a designed in order to enhance generalizability will also be study in Uganda reporting that 68%, 53% and 26% of discussed. respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD). Despite these SYMPOSIUM 6: Trauma and mental increased risks, the mental health of healthcare providers health in a global setting: Research within humanitarian contexts is often given little or no on refugees and displaced persons attention. The International Rescue Committee (IRC) works in more around the globe than 35 countries providing health care to people affected by conflict and disasters. Local health care workers in IRC The new H-5 model: Integrated holistic supported health facilities absorb a tremendous amount of approach for refugee humanitarian aide stress. In Liberia, Health Care Workers (HCW) have been exposed to stress and trauma for a protracted period of Richard Mollica time, both the primary stress of the direct danger of Department of Psychiatry, Harvard Medical School, Boston, MA, exposure to the Ebola Virus Disease in 2014 and the USA secondary stress of being exposed daily to the death and This paper presents a new approach to breaking down the suffering of their patients. silos to humanitarian aide to refugees worldwide. It builds There are tested interventions that have been shown to upon the H-Model which is gaining traction and attention improve the psychological wellbeing of healthcare globally due to its innovative "bottom up" workers. Systematic reviews of these interventions methodology. The WHO definition of health is redefined demonstrate that cognitive-behaviors techniques, to meet the current cultural and evidence-based view of mindfulness-based programs and self-help interventions health and wellness. The silos of safety and security, food, have a statistically significant improvement on self- shelter and water and infectious disease management are reported mental health, reducing perceived stress, anxiety broken down to include mental health and economic and and burnout, between pre and post intervention. Over the social development integrated at all levels of refugee last three years, the IRC has gained valuable insights on policy. The latter is achieved by following the new H-5 the positive effects of investing in the mental health of model which focuses on the restoration of wellness in HCWs through the Care for Caregivers project in Liberia. traumatized communities damaged by war and gender- The project aimed to improve the motivation, resilience based violence. The H-5 model includes major policy and and well-being of frontline HCWs through a staff support programmatic areas centered on the TRAUMA STORY of groups, facility workshops and individual counselling. the affected population including: 1) human rights, 2) Twenty-two health facilities in Montserrado county humiliation, 3) healing (self), 4) health promotion, 5) participated in this project. Habitat. The findings from project evaluations found that the staff Current research is provided that supports the H-5 model. support group was an extremely positive experience for HCWs, with HCWs reporting that they were taught how to regulate their emotions, which improved their ability to Care for Caregivers: Improving the mental cope with stress and manage their anger, and to improve health of Health Care Workers in their resilience to the daily stressors of being a HCW. The humanitarian settings project also led to a more positive work environment, with Mesfin Teklu Tessema reports of more respectful communication between The International Rescue Committee (IRC), New York, USA patients and colleagues, and increased motivation among HCWs to deliver higher quality care. Across diverse contexts, healthcare providers are documented to have an increased risk for depression and

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Challenges in assessing the mental health It is a well-established fact that mental health is influenced needs of refugees and displaced persons by prior trauma. Unfortunately, research has rarely looked Paul Bolton at several types of traumata simultaneously and rather Center for International Emergency, Disaster and Refugee focused on one type such as physical abuse, rape and Studies, Johns Hopkins University, Baltimore, USA war. Moreover, the evaluation of the effects of war While there is substantial evidence that many mental frequently misses not only other trauma such as childhood disorders described in the DSMV and ICD-11 occur across adversities (CA), but also family atmosphere and cultures there remain challenges in accurately identifying personality characteristics (sensitivity) and genes. disorders among refugees, displaced persons, and other A number of research projects conducted by IDRAAC, persons currently experiencing adverse circumstances. including the national study (L.E.B.A.N.O.N.; N=2,857 Situational challenges include the presence of physical adults), have highlighted the importance of studying the disorders that mimic mental disorders that are not short and long impact of CA on other major disasters such diagnosed and therefore not excluded. The presenter will as wars and armed conflicts. It is especially true that the discuss these and other challenges to identification of co-occurrence of adversities and war traumata does not mental disorders in these populations. He will also discuss happen at random. In another study on Syrian refugees approaches to dealing with these issues in order to (N= 579), we found that war had more of an impact on enhance the accuracy of mental health assessments. PTSD in children with lower levels of CA and higher levels of sensitivity. We are conducting a prospective study on a large sample War and Mental Health of Syrian refugee children in Lebanon (N=1600), in Elie Karam1,2,3, John Fayyad1,2,3, Dahlia Saab1, collaboration with Queen Mary University, exploring Claudia Farhat1, Lynn Itani1, Nadine Melhem4 biological pathways involved in refugee children’s 1Institute for Development, Research, Advocacy and Applied psychological response to war-related traumatic Care (IDRAAC), Beirut, Lebanon; 2Department of Psychiatry experiences. We have just completed the first wave of and Clinical Psychology, Balamand University Faculty of data collection. Some preliminary results might be ready Medicine, Beirut, Lebanon; 3Department of Psychiatry and for this conference. Clinical Psychology, St George Hospital University Medical 4 Center, Beirut, Lebanon; The Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

ORAL PRESENTATIONS

ORAL PRESENTATIONS SESSION 1: Introduction: A growing literature has examined the long- Substance use, adverse childhood term impacts of adverse childhood experiences (ACEs) events, and externalizing disorders such as child abuse on poor adult health outcomes. Spanking has shown a similar association with health across the life course outcomes, but to date has not been considered an ACE. The aims of this work will be to a) review the up-to-date OP01│ Spanking and adult mental health legal bans on corporal punishment from a global impairment: The case for the designation of perspective; b) review the most up-to-date data on spanking and mental health outcomes; c) using the spanking as an Adverse Childhood original CDC-Kaiser ACEs data, determine if spanking is Experience (ACE) empirically similar to physical and emotional abuse and Tracie Afifi1, Harriet MacMillan2 associated with similar mental health outcomes in 1University of Manitoba, Winnipeg, Canada; 2McMaster adulthood; and d) discuss spanking from a global human University, Hamilton, Canada rights perspective.

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Methods: Data were drawn from Wave II of the CDC- Methods: The associations were estimated by Kaiser ACE Study based on self-reports from adults in conventional cohort analyses using data on more than 100 southern California seeking routine health checks at an 000 children, including 33 000 siblings, from the outpatient clinic (N = 8316 ages 19-97 years). Mental Norwegian Mother and Child Cohort Study. These results health outcomes included depressed affect, moderate to were compared with estimates from analyses using a heavy drinking, street drug use, and suicide attempts. sibling-comparison design, adjusting for genetic and Confirmatory factor analysis and logistic regression environmental factors shared within families. Analyses models were conducted. compared children and siblings discordant for gestational Results: Spanking loaded on the same factor as the age group: early preterm (delivery before week 34), late physical and emotional abuse items. Furthermore, preterm (week 34-36), early term (week 37-38), term- spanking was associated with increased odds of suicide (week 39), term (week 40), term+ (week 41), and late term attempts (Adjusted Odds Ratios (AOR) = 1.37; 95% CI = (delivery after week 41). The outcome measures were 1.02 to 1.86), moderate to heavy drinking (AOR) = 1.23; maternally reported symptoms of ADHD in children at age 95% CI = 1.07to 1.41), and the use of street drugs (AOR) 5 and symptoms of inattention and = 1.32; 95% CI = 1.4 to 1.52) in adulthood over and above hyperactivity/impulsivity at 8 years. Covariates included experiencing physical and emotional abuse. This indicates child and pregnancy characteristics associated with both that spanking accounts for additional model variance and week of delivery and the outcomes. improves our understanding of these outcomes. Results: The results from the conventional analyses Conclusion: To date, 33 countries worldwide have legal showed that children born early preterm were rated with bans on spanking. Canada and the United States are not more symptoms of ADHD, inattention and among them. Our data indicate that spanking is empirically hyperactivity/impulsivity than term-born children were. The similar to physical and emotional abuse and including results of the sibling-comparison analyses indicated a spanking in these models adds to our understanding of causal relationship between early preterm birth and these mental health problems. Spanking should also be symptoms of ADHD in preschool children and inattentive considered an ACE in efforts to prevent violence and symptoms in school-age children. Prematurity did not improve mental health outcomes. Assuring safe, stable, influence hyperactivity/impulsivity. The causal effect on nurturing relationships and environments for all children is pre-school ADHD symptoms was more pronounced in essential for healthy growth and development, effective girls than in boys. parenting in the future parents, safer communities, and Conclusion: To our knowledge, this is the first study to stronger economies. show a causal relationship between gestational age at birth and dimensional measures of ADHD using a sibling- OP02│Gestational age at birth and comparison design. symptoms of ADHD in 5- and 8-year-old children: A population-based sibling- OP03│Very unsuccessful attempts to quit: comparison study Examining correlates from the Global Adult Helga Ask1, Kristin Gustavson2, Eivind Ystrom2, Tobacco Survey 1 1 Karoline Alexandra Havdahl 3, Martin Tesli4, Ragna Joao Mauricio Castaldelli-Maia , Laura Andrade , 2 Bugge Askeland1, Ted Reichborn-Kjennerud2 Silvia Martins 1 2 1Norwegian Institute of Public Health, Oslo, Norway; 2Norwegian University of Sao Paulo, Sao Paulo, Brazil; Columbia Institute of Public Health, University of Oslo, Oslo, Norway; University, New York, USA 3Norwegian Institute of Public Health, University of Bristol, Oslo, Bristol, Norway; 4Norwegian Institute of Public Health, Oslo Background: Every year, millions of smokers try to quit University Hospital, Oslo, Norway smoking. Unfortunately, a significant portion of these smokers fail to maintain abstinence for more than 24 Introduction: Preterm birth is associated with an hours, resulting in a Very Unsuccessful Attempt to Quit increased risk for ADHD. However, it is unknown whether (VUAQ). Previous studies have shown that VUAQ is this association reflects a causal relationship. The aim of related to both levels of nicotine dependence and the this study was to investigate if there is a causal severe symptoms of nicotine withdrawal. However, there relationship between gestational age and symptoms of are indications that other variables may also play a role. ADHD in preschool and school age children, adjusting for This study aims to investigate correlates of VUAQ using a unmeasured genetic and environmental factors. Possible large cross-national sample. sex differences in the associations were also investigated.

Book of Abstracts 20

Methods: We used data from the Global Adult Tobacco Lilian Ghandour, Sirine Anouti Survey (GATS) - designed to produce national estimates American University of Beirut, Beirut, Lebanon among all non-institutionalized men and women 15 years of age or older - from the 13 countries where almost 2/3 of A total of 1155 university students from 8 private and the World's smokers live. Smokers who reported having public universities from Lebanon participated in a survey tried to quit at least once were included in the analysis: in May 2016 aimed at understanding the association Bangladesh (n=1,058); Brazil (n=2,928); China (n=489); between policy-relevant factors and alcohol consumption. Egypt (n=1,577); India (n=3,499); Indonesia (n=821); Among past-year drinkers (n=582), 15% were screened Mexico (n=839); Philippines (n=1,288); Russia (n=1,403); with DSM-V moderate to severe alcohol-related problems. Thailand (n=1,503); Turkey (n=1,028); Ukraine (n=832); Compared to drinkers with no AUD, they were also more Vietnam (n=1,168). We carried out weighted regression likely to purchase their alcohol beverages mostly from models for VUAQ including sociodemographic, smoking pubs/bars [OR=2.43 (1.16, 5.08)] and to recall seeing (dependence levels), treatment (NRT, counselling, brief alcohol ads worn by sports players [OR=2.8 (1.70, 4.61)]. advice, or other), and media/perceptions as dependent Drinkers with moderate/severe alcohol problems (versus variables. no AUD) also believe that earlier closing times for Results: VUAQ varied from 1.0% in the Philippines to pubs/bars [OR=2.23 (1.48 -3.35)], banning all forms of 13.6% in Brazil. The category most consistently alcohol marketing [OR=1.8 (1.00, 3.24)], pricing associated with VUAQ was less time to first cigarette (7 promotions [OR=2.21 (1.33, 3.65)], as well as enforcing a countries), followed by being female and older (5 minimum BAC [OR=2.11 (1.07, 4.13)] would decrease countries) and cigarette advertising in stores (4 countries). their alcohol consumption levels, all probable points of Nicotine Replacement Treatment (NRT) was negatively entry for a national alcohol harm reduction policy, also associated with VUAQ in only two countries and supported by additional data including: (1) 40% of past- Counselling and Brief Advice in none. Smoking profile year drinkers reported drive through drinking stores that variables were important in all the continents. sell cheap low quality alcohol as their source of alcohol, in Sociodemographic variables had more effect in Latin addition to music concerts/other events; (2) only 8% of America. Media/Perception variables had more effect in past year drinkers (who reported drink-driving) were pulled Europe. NRT had no effect in Asia. over for a breath test; (3) 98% reported an alcohol outlet Conclusion: Our findings support both the multicausality near school/home, 88% perceived alcohol as easily and great variability of VUAQ. Although reinforcing the accessible, 92% had never been asked for ID when importance of dependence levels in many countries, the purchasing alcohol, and less than 1% have been refused use of medications that alleviate withdrawal, such as NRT, alcohol after they have had too much to drink; (4) and had hardly any effect. Interestingly, there is a justification lastly, students choice of alcoholic drink as well as brand for special interventions for women and the older, and also most recalled matched the alcohol brands most the banning of in-store advertising, in the attempt to advertised. In the absence of specialized care for people reduce VUAQ. with alcohol-problems, coupled with an alcogenic Funding: None. The Global Adult Tobacco Survey environment characterized by cheap, widely available and (GATS) functions as a multi-partner initiative that heavily advertised alcoholic beverages, Lebanon is one of represents global, regional, and national organizations. many countries that must strengthen their national We acknowledge WHO, CDC, GATS Implementing response via a contextualized evidence-based alcohol Agency, Johns Hopkins Bloomberg School of Public harm reduction policy. Health, RTI International, and the National Governments of Bangladesh, Brazil, China, Egypt, India, Indonesia, OP05│Specificity and patterns of physical Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, conditions with mood and anxiety disorder and Vietnam, for carrying out such an important survey, and releasing data for public use. subtypes in a nationally representative sample of US youth OP04│Linking DSM-V alcohol-use Emma K. Stapp, Jian-Ping He, Kathleen R. disorders with policy-relevant correlates in Merikangas National Institute of Mental Health, Bethesda, USA young adults: Implications for an evidence- informed national alcohol harm reduction Introduction: Although comorbid physical conditions are policy well-recognized in clinical samples of youth, there are limited data on patterns of comorbidity between mood and

Book of Abstracts 21

anxiety disorders in youth, particularly with respect to consequences from womb to specific subtypes representative of the general population. Our objective was to examine patterns and specificity of adulthood physical conditions with specific subtypes of mood and anxiety spectrum disorders in a nationally representative OP06│Individual variability in depression sample of youth. and anxiety symptoms and primary care Methods: The sample includes 6,483 adolescents aged 13-18 in the National Comorbidity Survey-Adolescent consultations over time: Longitudinal Supplement (NCS-A) with data on both mental disorders analysis of survey and linked administrative and physical conditions. Participants were directly data from the PATH through Life project interviewed with the Composite International Diagnostic Peter Butterworth Interview (CIDI) Version 3.0 that generates diagnoses for University of Melbourne, Melbourne, Australia DSM-IV disorders. Physical conditions were self-reported using a checklist method. Crosstabulation and logistic Introduction: Primary care is a key health service context regression models were used. Complex sampling design for common mental disorders such as anxiety and was taken into account in estimating prevalence and odds depression. There is, however, little research examining ratios and their variances. Models controlled for whether individual variability in mental health over time is demographic characteristics and comorbid psychiatric reflected in health service use. The current study draws on diagnoses. longitudinal survey data from a middle-aged community Results: Physical conditions were common in youth, cohort which is linked to administrative health service use especially headaches, allergies, skin conditions, and data. The study investigates the association between asthma. Metabolic conditions were associated with mood depression/anxiety symptoms and General Practitioner disorders whereas pain conditions were associated with (GP) service use over time, controlling for time-invariant anxiety disorders. Headache was associated with major differences between respondents, and seeks to quantify depression (OR 1.5, 95%CI 1.1-2.0), social phobia (OR this association at the population level. 1.6, 95% CI 1.1-2.3), and specific phobia (OR 1.4, 95% CI Method: Analysis of four waves of data for up to 12 years 1.1-1.6), whereas chronic pain (OR 1.8, 95% CI 1.1-3.0) from 2158 respondents in the middle-aged cohort of the was more common among those with bipolar disorders. PATH through Life project. At each wave, data was Asthma, heart conditions, and seasonal allergies were not collected on anxiety and depression symptoms (assessed more likely among any subtypes of mood and anxiety using the Goldberg Anxiety and Depression scales), disorders. Agorahobia and generalized anxiety disorder socio-demographic characteristics, chronic physical were not associated with greater risk of physical conditions, and physical functioning. Administrative data conditions. In contrast, separation anxiety disorder was on number of primary care consultations during the six- associated with the greatest frequency of physical months surrounding respondents' interviews were drawn conditions. from Australia's universal health insurance scheme Conclusions: Patterns of physical-mental comorbidity (Medicare). Negative binomial GEE and random-effects may provide insight into the heterogeneity of etiology of models assessed the association between these conditions. Likewise, both physical and mental depression/anxiety symptoms and number of GP conditions should be considered in assessing disability consultations, examining both between-person and treatment planning. differences and within-person changes in symptoms over Funding: The National Comorbidity Survey-Adolescent time. Population Attributable Fractions contrasted the Supplement (NCS-A) was supported by the National proportion of GP consultations explained by different Institute of Mental Health (U01-MH60220 and ZIA MH factors. 002808) and the National Institute of Drug Abuse Results: There was a linear association between number (R01DA016558). of depression/anxiety symptoms and number of GP consultations: a difference of three symptoms between ORAL PRESENTATIONS SESSION 2: people was associated with a 10% difference in GP consultations, and a change of three symptoms over time Suicidality, depression and anxiety: was associated with an 8% change in GP consultations. In Understanding etiology and health the final model, psychiatric morbidity explained just over 17% of GP consultations, comparable in magnitude to chronic physical conditions, physical functioning limitations, and key socio-demographic factors.

Book of Abstracts 22

Conclusion: Depression and anxiety symptoms are a among the non-engaged ones. For the engaged services major determinant of primary care consultations. users, no improvement of depression symptoms and Importantly, by using longitudinal data, the current study requiring secondary mental healthcare services were shows that primary care service use mirrors change in revealed to increase the risk of general mortality after individuals' symptoms over time. confounding control. More visits to IAPT services and ever The PATH through Life project has been funded by grants taking high-intensity treatment were also associated with from the National Health and Medical Research Council lower general mortality significantly. and support from Safe Work Australia. Conclusion: Patients who engage with IAPT services have lower all-cause mortality than the general population. OP07│General and suicide mortality among The extent to which this is due to the protective effect of people receiving cognitive behavior psychological therapy or to selection factors needs further investigation. therapies in a community setting 1 2 3 Chin-Kuo Chang , Jong-Sun Lee , Richard Hayes , OP08│Association between parental age, Robert Stewart3, Janet Wingrove3, Matthew Hotopf3 1University of Taipei, Taipei City, Taiwan; 2Kangwon National offspring psychopathology, and University, Kangwon, Korea Republic; 3King's College London, neurocognitive performance in the London, United Kingdom Philadelphia Neurodevelopmental Cohort Alison K. Merikangas1,2, Monica E. Calkins2, Introduction: The Improving Access to Psychological Warren B. Bilker3, Kosha Ruparel2, Tyler M. Moore2, Therapies (IAPT) program has provided evidence-based 2 2 psychotherapies for depression and anxiety disorders in Ruben C. Gur , Raquel E. Gur 1Department of Biomedical and Health Informatics, Children's England since 2007. However, up to now, its impact on Hospital of Philadelphia, Philadelphia, PA, USA; 2Department of mortality, especially for suicide mortality, has not been Psychiatry, Neuropsychiatry Program, Perelman School of studied. We thus aimed to investigate the association Medicine, University of Pennsylvania, Philadelphia, PA, USA; between IAPT engagement and mortality, including 3Department of Biostatistics and Epidemiology, Perelman suicide. School of Medicine, University of Pennsylvania, Philadelphia, Methods: We conducted a retrospective cohort study PA, USA consisting of psychological therapy service users in community with anonymized electronic mental health Introduction: There is abundant evidence that parental records from a southeast London catchment, linked to age is associated with neurodevelopmental and national death certification, following IAPT referrals behavioral disorders in offspring; however, the between 1 May 2009 and 31 March 2015. The exposures mechanisms for these associations are unknown. A of interest were engagement to IAPT therapies, referral potential explanation for these associations is cognitive and psychotherapy methods, and symptom level changes function, which has also been shown to be impacted by for anxiety and depression. Age- and gender-standardized parental age. The aim of this research is to examine the mortality ratios (SMRs) for general and suicide mortality associations between parental age at birth, offspring were first calculated for all service users, then stratified by psychopathology, neurocognition, and cortical engagement and gender. Suicide mortality was analyzed morphology in a community-based sample of adolescents. in competing-risk Cox regression models by univariate Methods: 9498 youths (ages 8-21 years) participated in and multivariate analyses. the Philadelphia Neurodevelopmental Cohort study: Results: In 104,994 catchment residents receiving IAPT different subsets completed the psychopathology and services, 763 deaths were identified, including 36 suicide neurocognitive assessments, and multimodal deaths. The SMR for suicide was elevated among all IAPT neuroimaging. Crude and adjusted regression models with service users (1.82; 95% CI: 1.27, 2.52) and in those with parental age predicting offspring psychopathology, non-engagement (2.08; 1.37, 3.02). SMRs for all-cause neurocognition, and cortical morphology were completed. mortality were raised in IAPT users with non-engagement Adjustment variables include demographic factors and (1.19; 1.10, 1.29), lowered for those who engaged (0.65; social environmental variables. 0.55, 0.77), mostly accounted for by cancer and circulatory Results: After controlling for sociodemographics and diseases as causes of death, and were not raised overall. comorbid psychopathology, both younger maternal and With confounding considered, a mental disorder other paternal ages were associated with behavior syndromes than anxiety or depression requiring secondary mental and psychosis, whereas advanced paternal age was healthcare was found a major reason for suicide mortality associated with pervasive developmental

Book of Abstracts 23

disorders/autism. After controlling for sociodemographics dysregulation and cognitive decline and that depressive and the social environment, the only significant symptoms tend to precede this decline. neurocognitive associations were between maternal and parental age and the speed of complex cognition. OP10│Absolute and relative risks for Conclusions: These findings suggest that younger and suicidality, violence perpetration and older parental ages at birth are associated with specific forms of psychopathology and neurocognition in offspring. victimization, and premature death in a The persistence of the influence of parental age after cohort of young adults discharged from control for sociodemographic factors suggests that inpatient psychiatric care additional explanations for these findings should be Florian Walter1, Matthew J. Carr1, Pearl L.H. Mok1, examined in future studies. Enhanced performance Sussie Antonsen2,3, Carsten B. Pedersen2,3, Jenny among offspring of older parents suggests that cognitive Shaw1, Roger T. Webb1 function does not influence the association between 1Centre for Mental Health and Safety, University of Manchester, advanced parental age and psychopathology. Manchester, United Kingdom; 2Centre for Integrated Register- Funding source: The study was supported by RC2 grants based Research, CIRRAU, Aarhus University, Aarhus, from the National Institute of Mental Health (NIMH): Denmark; 3National Centre for Register-based Research, MH089983 and MH089924 (R.E. Gur and H. Business and Social Sciences, Aarhus University, Aarhus, Hakonarson). Dr. Merikangas has received support from a Denmark NIMH T32 grant to R.E. Gur (MH019112). Introduction: Young persons discharged from inpatient OP09│Cardiometabolic dysregulation and psychiatric care are at elevated risks for a range of adverse outcomes, including premature death, non-fatal cognitive decline: Potential role of and fatal violence perpetration and victimization and self- depressive symptoms harm. However, no previous research has reported on Norbert Schmitz1, Sonya Deschênes1, Rachel such a broad array of adverse outcomes in a single study Burns1, Sofia Danna1, Oscar Franco2, Arfan Ikram2, cohort. We examined risks across multiple endpoints Mika Kivimaki3, Archana Singh-Manoux3, Tiemeier among discharged young adults in a national cohort. Henning2 Methods: We conducted a matched cohort study of all 1McGill University, Montreal, Canada; 2Erasmus University, persons born in Denmark during 1967-1996. Each Rotterdam, Netherlands; 3University College London, London, discharged patient was matched on date of birth and United Kingdom gender with 25 comparison subjects without a history of psychiatric admission. We calculated cumulative Background: Previous studies have examined incidence and hazard ratios to estimate absolute and associations of cardiometabolic factors with depression relative risks, respectively, among discharged patients and cognition separately. versus persons not admitted, for: (a) all-cause mortality; Aims: To determine if depressive symptoms mediate the (b) suicide; (c) accidental death; (d) homicide association between cardiometabolic factors and cognitive victimization; (e) homicide perpetration; (f) non-fatal self- decline in two community studies. harm; (g) violent criminality; (h) and hospitalization Method: Data for the analyses were drawn from the following interpersonal violence. Rotterdam Study, the Netherlands (n = 2940) and the Results: Risks for all adverse outcomes examined were Whitehall II study, UK (n = 4469). markedly elevated in the cohort of discharged patients. Results: Mediation analyses suggested a direct Within 10 years of their first discharge, 1 in 19 of these association between cardiometabolic factors and cognitive patients will have died from any cause (1 in 60 by suicide, decline and an indirect association through depression: 1 in 2000 by homicide), 1 in 555 will have perpetrated poorer cardiometabolic status at time 1 was associated homicide, 1 in 4 will have harmed themselves non-fatally, with a higher level of depressive symptoms at time 2 and 1 in 13 will have been convicted of committing a (standardised regression coefficient 0.07 and 0.06, violent crime. For self-harm and suicide, especially large respectively), which, in turn, was associated with greater risk elevations were seen in the first year post-discharge, cognitive decline between time 2 and time 3 (standardised whereas for violent criminality and accidental death the regression coefficient of -0.15 and -0.41, respectively). level of risk elevation remained relatively constant Conclusions: Evidence from two independent cohort throughout the 10-year period. studies suggest an association between cardiometabolic Conclusion: People discharged from inpatient psychiatric care are at much higher risk than the rest of the population

Book of Abstracts 24

for experiencing a broad range of fatal and non-fatal the longer term. Future research should focus on adverse outcomes. Our findings indicate the need for explanatory models and the elucidation of causal optimized inter-agency cooperation to address these pathways. multiple vulnerabilities, soon after discharge as well as in

POSTER PRESENTATIONS (PP01-PP76)

PP01│Mental health in Ethiopia: psychiatric hospital in Addis Ababa available for patients Psychosocial support service for refugees with mental diseases. There was a total of 34 psychiatrists, and 27 of them worked in the capital. and research approaches First solutions: Our main aims in Ethiopia have been and Kristina Adorjan1,2,3, Michael Odenwald4,5, Marina still are: (1) construction of psychiatric care through training Widmann4,5, Sisay Mulugeta6, Markos Tesfaye6, Fasil of mental health masters, (2) multiplication of health Tessema7, Stefan Toennes8, Sultan Suleman9, Sergi workers trained in psychiatry, (3) decentralization of mental Papiol1, Matiwos Soboka6, Zeleke Mekonnen10, health care in Ethiopia and (4) supply of rural population Brigitte Rockstroh4, Marcella Rietschel11, Oliver through health centers. To achieve these goals a program Pogarell2, Ezra Susser12,13, Thomas G. Schulze1 called "Master of science in integrated clinical and 1Institute of Psychiatric Phenomics and Genomics, Munich, community mental heath care" was established at Jimma Germany; 2Department of Psychiatry and Psychotherapy, University (JU). In a two-years course nurses and Ludwig Maximilians University, Munich, Germany; 3Center for employees in the health care sector were trained in International Health, Ludwig Maximilians University Munich, psychiatry. After five years 42 students finished the Germany; 4Department of Psychology, University of Konstanz, program successfully. Graduates have spread over the Konstanz, Germany; 5vivo international e.V., Germany; country and work in different regions of Ethiopia. None of 6 Department of Psychiatry, Jimma University, Jimma, Ethiopia them has left the country for better living and working 7Department of Epidemiology, Jimma University, Jimma, conditions in western countries. One of the graduates Ethiopia; 8Department of Forensic Toxicology, Goethe University, Frankfurt am Main, Germany; 9School of Pharmacy, works in a refugee camp in Dolo Ado on the establishment Faculty of Health Sciences, Jimma University Institute of Health, of a comprehensive mental health and psychosocial Jimma, Ethiopia; 10Department of Medical Laboratory Sciences support service for refugees (Adorjan K [...] Schulze TG: and Pathology, Jimma University, Jimma, Ethiopia; Psychiatric care of refugees in Africa and the Middle East: 11Department of Genetic Epidemiology in Psychiatry, Central Challenges and solutions, 2017). Institute of Mental Health, Medical Faculty Mannheim, University Research activities: The Jimma University in of Heidelberg, Heidelberg, Germany; 12Mailman School of Public southwestern Ethiopia has a unique health and Health, Columbia University, New York, USA; 13New York State demographic surveillance system called "Gilgel Gibe Field Psychiatric Institute, New York, USA Research Center" (GGFRC) with a catchment area of

about 60.000 people. In this setting, we studied the effect Background: In Ethiopia but also in other countries of the of khat use as risk factor for the development and the sub-saharen Africa we currently observe two phenomena: stability of psychotic symptoms as well as of symptoms of (1) "brain drain" which is defined as a migration of highly common mental disorders among young men in the educated and talented people from low-income countries community. Furthermore, we wanted to demonstrate the to western countries since the living and working reliability and validity of research methods that are conditions are better there and (2) the centralization of necessary for future genetic epidemiological studies, i.e. medical care which means that trained medical doctors the validity and reliability of pharmacological screening work primarily in the capital and in major cities; a trend that tests as well as assessments performed by trained local leads to medical undersupply of the population in remote interviewers. Our study was the first regions. psychopharmacological study in cooperation between the In 2009 only 45% of the Ethiopians had access to the Institute of Psychiatric Phenomics and Genomics (IPPG) health system, 80% of the medical doctors have left the in Munich, Germany and the JU in Ethiopia. Under country in recent years, and there were all together only suboptimal conditions (high temperatures, limited 900 medical doctors in Ethiopia. According to the WHO refrigeration options, lack of infrastructure), we collected report in 2006 there were three non-psychiatric care biological samples and analyzed them on site. centers, six inpatient treatment centers, and one

Book of Abstracts 25

Design: Trained raters interviewed participants at two Future plans: Our project can be seen as a pilot and subsequent time points, i.e. during the dry season (T1; feasibility study to prepare a comprehensive population- N=853) and during the rainy season nine months later (T2); based genetico-epidemiological study on various gene- N= 695). They assessed (1) khat use during the past 7 environment interactions that should be carried out in the days with the TLFB diary, (2) psychotic symptoms very near future. The infrastructure of GGFRC offers us a experienced during the past 6 months with four CIDI items unique opportunity to build collectives of multiple-thousand selected on the basis of previous studies and (3) potentially people in a shortest period of time and to perform genetic traumatic experiences by an adapted version of the LEC-5 studies as they have not yet been taken in Africa in this (T1: exposure until T1; T2: additional exposure since T1, form so far. The extensive epidemiological registration of a i.e. recent trauma; lifetime exposure is defined as the sum population of 60.000 people, the stable population of events T1+T2). Urine samples were collected to analyze structure, and the quit stable environment, such as the khat alkaloids through immunoassay tests for urban and rural way of life with all its characteristics of an amphetamine. Two to 14 days after T1, mental health African country provide ideal conditions for this. The experts reassessed khat use and psychotic symptoms in a population is ideally suited to study the impact of polygenic randomly selected subgroup of 125 individuals. Urine risk profiles of various psychiatric disorders on behavioral samples were taken for amphetamine-immunoassay traits and their interaction with environment. analysis and quantitative detection of norephedrine using Based on our experiences in teaching and research, the HPLC. Federal Ministry of Health in Ethiopia asked us to help to Results: Khat use was associated with the presence of establish a first rehabilitation farm in Ethiopia for patients "khat-induced" psychotic symptoms, - particularly at T1V with substance use disorders (alcohol, khat and cannabis). as the most valid indicators of both khat use (HPLC) and In the Amhara region, north of the capital Addis Ababa, a khat-induced psychotic symptoms were collected. During rehabilitation center should be established. In this region the rainy season (T2) immunoassay test and lifetime especially, young people suffer from substance use history of traumatic events varied with the prevalence of disorders which can not be treated adequately due to the "khat-induced" psychotic symptoms; focusing on current lack of mental health care. Through an evidence- individuals with positive immunoassay test, among 121 based rehabilitation program patients should be treated with up to three potentially traumatic experiences the professionally and on that basis find a way back to work prevalence was 14.0%, and among 124 with more than and to their social and family life. three such events it was 26.6% (p=.015). Results were attenuated during dry season (Adorjan K [...] Schulze TG: PP02│Investigation of androgens' serum Khat use and occurrence of psychotic symptoms in the general male population in Southwestern Ethiopia: levels in pre-pubertal male autistic children 1 2 evidence for sensitization by traumatic experiences, World Abdelfattah Alhader , Mohammad Gharaibeh , 1 3 Psychiatry, October 2017). Mahmoud Alfaqih , Mohammad Nazzal Conclusions: In this study, we added some new findings 1Department of Physiology & Biochemistry, Faculty of Medicine, 2 to the scientific discussion on the sensitization hypothesis JUST, Irbid, Jordan; Department of Medical Laboratories, Faculty of Applied Medical Sciences, JUST, Irbid, Jordan; - besides the fact that this is the first study to report on a 3Rehabilitation Sciences Department, Faculty of Applied Medical serious problems of some low-income countries like Sciences, JUST, Irbid, Jordan Ethiopia where khat chewing is highly prevalent: Not in a specific subgroup (that might be especially prone Introduction: Recent advances in research addressing to substance abuse) but in the general Ethiopian male Autism spectrum disorders (ASD) have linked the population the interaction of the environmental risk factors development of this disease to multiple factors like: khat and trauma act in a similar way on psychotic symptom immune dysfunctions, several environmental factors and development like is has been shown for cannabis and changes in the levels of various hormones, including trauma. androgens. Studies on the association of ASD and The sensitization by traumatic experiences for the androgens are controversial and conflicting. Scientific psychotomimetic effects of substances might not just be reports on the levels of androgens in autistic children limited to childhood experiences but might involve ranged from no detectable changes to increased serum experiences from the whole lifetime. levels during selective periods of human growth. The changes in availability of khat have an effect on the Design: A case-control study was utilized to explore any presentation of "khat-induced" psychotic symptoms and in possible changes in the blood levels of androgens, sex- the season with high availability the sensitization effect seems to be larger.

Book of Abstracts 26

hormone binding globulin and their potential involvement Data were collected through face-to-face interview with in the pathogenesis of autism in Jordanian children. semistructured preformed, pretested questionnaire and Methods: In this study, serum levels of total testosterone analyzed by SPSS software 16.0 version. (TT), dehydroepiandrosterone (DHEA), sex-hormone Results: Most of the patients (93%) were male, 60% were binding globulin (SHBG), follicle-stimulating hormone married, 62% were urban habitant, 42% were under grade (FSH) and luteinizing hormone (LH) were investigated in 10, and 33% were service holder. Total 55% of the patients 32 Jordanian autistic male patients and in 32 healthy age- had misconceptions and 29% visited only for matched children. Hormones were measured in blood misconception; 14% had Premature Ejaculation; and 12% samples using Chemmiluminescence Immunoassay had desire disorder. 32% of the patients had psychiatric available in the Laboratory Department at KAUH. disorders and among them depression was most common, Independent t-test was used to investigate statistical 13%. significance in study groups with a (p) value of less than Conclusion: Positive openness in sexual health and 0.05 was considered significant. appropriate strategy should be taken to improve the quality Results: In autistic group TT and DHEA levels were of sexual life as well as reduce the misconception in the significantly higher compared to the control group by 120% people of Bangladesh. and 50%, respectively. TT had a positive strong correlation with DHEA (r=+62, p≤0.001), suggesting an adrenal PP04│Demography and risk factors of source of the elevated androgens. SHBG and FSH serum suicide in Bangladesh: Six-month paper concentrations were significantly lower in autistic patients compared to the control group by 55% and 33%, content analysis respectively. Serum LH levels showed no significant Md. Mohsin Ali Shah, Srijony Ahmed, S.M. Yasir differences between both groups. Arafat Conclusion: Our results demonstrate a significant Department of Psychiatry, Bangabandhu Sheikh Mujib Medical hormonal imbalance in autistic children in comparison to University, Dhaka, Bangladesh age-matched control group. The demonstrated increase in androgens in pre-pubertal male autistic children further Introduction: Suicide is a global public health problem too substantiates the postnatal role of androgens, SHBG and often neglected by researchers and Bangladesh is not an FSH in the pathogenesis of autism. Further studies are exception. There is no suicide surveillance and nationwide needed to elucidate their role as diagnostic biomarkers and study is yet to be conducted in the country. It was aimed to the potential ameliorating effect of anti-androgen therapy look into the suicide based on newspaper reporting in in autism. Bangladesh focusing the demographic variables and risk factors. PP03│Burden of misconception in sexual Methods: 6 national newspapers were scrutinized since November 2016 to April 2017. Data were checked, health care setting: A cross-sectional crosschecked and then analyzed with SPSS software. investigation among the patients attending Results: In six month duration total 271 cases were a psychiatric sex clinic of Bangladesh reported; age was found 11-70 years, (26.67±13.47). 61% S.M. Yasir Arafat, Srijony Ahmed (83) of the reported cases were less than 30 years of age, Department of Psychiatry, Bangabandhu Sheikh Mujib Medical 58% were female, 24% (64) were student, 17% were University, Dhaka, Bangladesh house maker, 61% from rural background, and 45% were married. Hanging was found as the commonest method Introduction: Bangladesh is a country in South Asia with (82.29%); marital and familial discord remained as a about 160 million people and achieved health related noticeable risk factor 34.32%. Family members and Millennium Development Goals (MDG) significantly. But neighbors noticed 103 (38%) cases, and only 3 cases were sexual health is still an untapped issue with predominant found to have suicide notes. myths and misconception. We aimed to look into the Conclusion: Suicide is an under attended public health proportions of patients attending sexual health care problem in Bangladesh with few research and paucity of services due to misconceptions. literature. Nationwide survey conduction and Methods: The descriptive, cross-sectional study was establishment of national suicide surveillance is now a time conducted among 110 patients attending Psychiatric Sex demanded step. Clinic (PSC) of Bangabandhu Sheikh Mujib Medical University. Respondents were included in the study with convenient sampling from November 2016 to March 2017.

Book of Abstracts 27

PP05│Prevalence of mental disorders and Conclusions: Mental disorders pose a tremendous public associated service use in adolescents and health problem requiring considerably intensified efforts into recognition and treatment as well as identification of young adults: A regional cross-sectional risk factors and effective preventive interventions. epidemiological study in Germany Funding: The BeMIND study program has been funded by Katja Beesdo-Baum, John Venz, Catharina Voss, the German Federal Ministry of Education and Research, Lars Pieper grant numbers: 01ER1303/01ER1307. Technische Universität Dresden, Dresden, Germany PP06│Implementation of the PAX-Good Introduction: Prevalence estimates for mental disorders behavior game in indigenous communities: are crucial for service planning and timing of etiological and pathogenetic research efforts. The "Behavior and Mind Perspectives of school personnel and Health (BeMIND) Study" is a multi-faceted prospective- community members longitudinal epidemiological study program among Mariette Chartier1, Gia Ly1, Nora Murdock2, Roberta adolescents and young adults in Germany aiming to Woodgate1, Janique Fortier1, Gary Munro3, Jitender provide novel insights into the etiology and pathogenesis Sareen1 of mental disorders. Aim of the present analysis is to 1University of Manitoba, Winnipeg, Canada; 2Manitoba First provide prevalence estimates for a broad range of mental Nations Education Resource Centre, Winnipeg, Canada; 3Cree disorders according to most recent diagnostic criteria as Nation Tribal Health Centre, The Pas, Canada well as related service use. Methods: Symptoms, syndromes and diagnoses of mental Introduction: Rates of suicide and suicide attempts of disorders (depressive, bipolar, anxiety, trauma-/stressor- Indigenous youth in Canada are alarmingly high and have related, obsessive-compulsive or related, eating, somatic been identified internationally as a major public health symptom or related, attention-deficit/hyperactivity, concern. PAX Good Behaviour Game (PAX-GBG) is a disruptive-/impulse control/conduct, alcohol/tobacco/drug school-based mental health promotion strategy shown to use, psychotic) were assessed face-to-face via decrease suicidal behaviours, tobacco, aggressive standardized interview (updated epidemiological research behaviors, alcohol and drug use as well as improve version of the DIA-X/CIDI) by trained clinical interviewers academic achievement in children and youth. There is a in a random community sample of N = 1180 adolescents paucity of research investigating PAX-GBG when and young adults aged 14 to 21 in Dresden (Germany) in implemented under real-world conditions, particularly in 2015/16. Service use corresponds to positive Indigenous communities. This qualitative study examined endorsement of any contacts to the health care system due the implementation of PAX-GBG in Indigenous to mental or substance use problems. communities in Northern Canada. Results: Four in ten of the adolescents and young adults Methods: The team conducted three focus groups with met criteria for any mental disorder in the past year; five in community members and eight one-on-one interviews with ten at some point in the lifetime. Weighted lifetime school personnel using a semi-structured interview guide. prevalence for individual diagnoses was highest for (mostly Content analysis was conducted through line by line mild) tobacco use disorder (15.5%) and alcohol use analysis, isolating patterns and uncovering emerging disorder (15.2%) in males and Major Depression (21.7%) themes from the data. and (mostly mild) tobacco use disorder (18.1%) in females. Results: PAX-GBG was viewed as a gentle approach that The substance use conditions were also most prevalent helped students with behavior management, self- during the past 12-months in both genders; in girls, specific regulation, and coping with life's challenges. This was phobia was the most prevalent 12-month diagnosis. deemed consistent with traditional values of love and Females were significantly more often affected by anxiety, respect. Challenges included high teacher turnover, post-traumatic, somatic symptom, major depressive, and students transferring during the school year, adapting for eating disorders whereas males were more frequently small and multi-level classrooms and for children with affected by alcohol use, cannabis use, intermittent developmental disabilities. Cultural adaptations were explosive and childhood onset conduct disorder. Of those suggested: incorporating cultural teaching, legends, meeting criteria for any mental disorder, less than one third traditions and values and translating PAX-GBG posters reported any service use; another 14.1% had thought into Indigenous languages. Participants described their about seeking help or were recommended by others to do community and the challenges they must contend with, so. thus providing a greater contextual understanding necessary for successful program implementation. They

Book of Abstracts 28

spoke of high levels of historical trauma, poverty, violence age 30 to 35 years old). It also increased the risk of suicidal and addictions and a troubled relationship between school death (hazard ratio (HR): 2.41), suicide attempts (HR: and parents. Solutions to address PAX-GBG 3.05), public housing use (HR:1.44), income assistance implementation challenges included: expanding the use (HR: 2.07), criminal accusation (HR:1.53), and criminal program from only first graders to all grade levels, victimization (HR:1.54) in adulthood. Similarly, but to a enhancing training and ongoing support to teachers, greater extent, suicide attempts in adolescence increased providing special training to student leaders and involving the risk of suicidal death (HR:3.65), suicide attempts them in program implementation, as well as engaging (HR:5.68), public housing use (HR:1.64), income parents and the wider community through community assistance use (HR:1.68), criminal accusation (HR:2.18), events, workshops and materials designed for parents. or criminal victimization (HR:2.43) in adulthood. Conclusion: PAX-GBG was perceived as acceptable, Conclusion: Young people's mental health status has culturally appropriate, feasible and sustainable in significant influence on their trajectories of health and well- Indigenous communities. Successful adoption was being into adulthood. This enhanced knowledge could demonstrated in two of the three communities studied. directly inform policy and practice to provide better These findings are informing future adaptation and population-based mental health promotion, prevention and program implementation in Indigenous communities. early interventions for children and adolescents with mental disorders and subsequently prevent these adverse PP07│Childhood mental disorders and adult outcomes in the future. subsequent adverse outcomes in early adulthood: A population-based longitudinal PP08│Scoping review of evidence-based study interventions for adolescents with Mariette Chartier1, James Bolton2, Okechuwu depression and suicide related behaviors in Ekuma2, Natalie Mota2, Jennifer Hensel2, Leonard low and middle-income countries MacWilliam2, Yao Nie2, Chelsey McDougall2 Sarantsetseg Davaasambuu1, Milton Wainberg2, 1Manitoba Centre for Health Policy, University of Manitoba, Phillip Hamid3, Peter Szatmari4 Winnipeg, Canada; 2University of Manitoba, Winnipeg, Canada 1Research Foundation, CUNY, New York, USA; 2Columbia University, New York, USA; 3City University of New York, New Introduction: While previous research has increased our York, USA; 4The Cundill Centre for Child and Youth, Toronto, understanding of the relationship between childhood and Canada adolescent mental disorders and adult outcomes, the clinical samples and surveys on which they are based are Background: Depression is the number one cause of prone to a number of biases. To our knowledge, no disability for adolescents. Adolescents who suffer from previous studies have followed a cohort of children using depression are more likely to engage in risky behaviors administrative data which addresses the challenges of such as substance abuse, unsafe sexual behaviors and selection bias, recall bias, and self-reporting. The objective violence. Moreover, depression is the second highest of this study was to examine the associations between cause for death by suicide among adolescents worldwide. diagnosed mental illness and suicidal behaviours in Aims: To map a body of depression and suicide prevention childhood and adolescence, and adverse outcomes in evidence-based interventions for adolescents in LMICs early adulthood. and to disseminate findings of evidence-based Methods: Using de-identified administrative databases interventions. from the Manitoba Population Research Data Repository, Methods: An established five-stage process for scoping we created a birth cohort of 60,838 residents of Manitoba, reviews was utilized: (1) identifying research question; (2) Canada, born from fiscal years 1980/81 to 1984/85 and identifying literature; (3) selection of randomized control followed them to the end of study period in 2014/15. We trials (RCTs); (4) presenting data; and (5) collating, used survival analysis, controlling for key childhood summarizing and reporting results. covariates, to determine whether people diagnosed with Results: A Total of 28 RCTs conducted in 15 different mental disorders in childhood or adolescence were at LMICs between 1995 and 2016 were reviewed. Nine higher risk of early adverse adult outcomes than those with different interventions have been evaluated to see if they no childhood mental disorders. improve depressive symptoms and suicide prevention Results: Having a diagnosis of a mental disorder in among adolescents. Sixteen of the twenty-eight RCTs childhood or adolescence increased the risk of being achieved statistically significant results. diagnosed with the same disorder in early adulthood (at

Book of Abstracts 29

Conclusion: Considering that 2/3 of the world's countries low depressive symptoms, however cvBRS was not meet criteria for LMIC status and 75% of suicides occur in influenced by depressive symptoms in the present study. LMICs, it is surprising that so few RCTs addressing Importantly, depressive symptoms were an independent depression and suicide have been conducted in these predictor of cfPWV when controlling for traditional countries. This dearth of information poses challenges to cardiovascular co-variates. Future directions of this development and deployment of effective interventions. research will involve investigation of the role of pro- inflammatory cytokines on the association between PP09│Effects of depressive symptoms on depressive symptoms and arterial stiffness in healthy young adults. central arterial stiffness in healthy young Funding source: Canadian Institute for Health Research. adults Kylie Dempster, Deborah O'Leary, Terrance Wade Brock University, St. Catharines, Canada PP10│Formal, informal and school-based mental health service use patterns among Introduction: Cardiovascular disease (CVD) and mental adolescents: Does adversity matter? health disorders are of public health importance. Melissa DuPont-Reyes1, Alice Villatoro1, Jo Phelan2, Specifically, depression is now considered a risk factor for Kris Painter3, Bruce Link4 ischemic heart disease and CVD. Adaptations in carotid- 1Latino Research Initiative, The University of Texas at Austin, femoral pulse wave velocity (cfPWV), the gold standard Austin, USA; 2Department of Sociomedical Sciences, Columbia assessment of central arterial stiffness, and cardiovagal University Mailman School of Public Health, New York City, USA; baroreflex sensitivity (cvBRS), a measure of blood 3Substance Abuse and Mental Health Services Administration, pressure regulation, have been observed among healthy Rockville, USA; 4School of Public Policy, University of California, adolescents with high depressive symptoms, and middle- Riverside, Riverside, USA aged adults with and without clinical depression. The present study examined the association between Introduction: Adults play a critical role in adolescent depressive symptoms, cfPWV, and cvBRS in healthy mental health help-seeking. However, adolescents young adults. experiencing adversity may lack adult social capital to Methods: Fifty (28 females) healthy young adults assist with treatment entry. To understand help-seeking participated in the present study. cfPWV (m/s) was from the adolescent perspective and to better inform assessed in the supine position using applanation mental health support for adolescents, we examine tonometry at the common carotid and femoral arteries with patterns in formal, informal, and school-based mental distances measured relative to the suprasternal notch. health service use among adolescents experiencing cvBRS (ms/mmHg) was determined via spectral analysis adversity. in the low-frequency (0.04 - 0.15 Hz) band. Depressive Methods: A diverse sample of sixth-graders (N=751) were symptoms were determined using the Centre for analyzed using baseline data from a school-based anti- Epidemiological Studies Depression Scale and stigma intervention study. Participants completed self- dichotomized into low (<16) and high (≥16) depressive administered surveys that assessed mental health symptoms based upon published standards. Physical symptoms, perceived mental health problem, and help- activity was assessed using the International Physical seeking behaviors. Adjusting for sociodemographics, Activity Questionnaire and current smoking status family cohesion, and aggressive behaviors, logistic assessed as never, occasional, and daily. regressions examined patterns in help-seeking across Results: cfPWV was significantly elevated in the high different types of adversity: older-aged student, poverty depressive symptoms group (p = 0.01) although no group status, broken/disrupted parent union, and mental differences were observed in BP, HR, cvBRS, or illness/substance abuse in the family. Mental health anthropometric variables (p > 0.05; all). Depressive service outcomes included formal services such as primary symptoms group was a significant predictor of cfPWV and specialty care, parents, and school-based support independently and after accounting for associated including school counselor and friend. cardiovascular variables (R2 = 0.4484, AdjR2 = 0.3677, p Results: Among the total sample, talking to a parent for a = 0.0003). Depression remained significant after further mental health problem was most common (19%), followed accounting for smoking status and physical activity (PA) by doctor or friend (17%), taking medication (15%), and (days/week of moderate PA). school counselor (11%); less than 10% reported talking to Conclusion: cfPWV was elevated in healthy young adults a therapist or priest. Adolescents with mental with high depressive symptoms compared to those with illness/substance abuse in the family compared to those

Book of Abstracts 30

without it had twice the odds of seeking a friend and school problems, and 0.2 (95% CI 0.1, 0.3) lower point score on counselor; those with high-level symptoms and a emotional well-being and 0.3 (95% CI 0.2, 0.4) on prosocial perceived problem reported three times the odds of using behaviors. school-based services compared to those with low Conclusion: A later chronotype was associated with symptoms and no perceived problem, respectively. poorer mental health, independent of sleep duration and Adolescents experiencing poverty versus not had twice the school start time, and across internalizing and odds of seeking formal services. Adversity did not externalizing mental health domains. Further research is influence seeking help from a parent. Models stratified by needed to clarify the mechanisms underlying this symptom levels and perceived problem showed consistent association. The timing of sleep, and not just its duration, patterns to the total sample (interactions non-significant). may be an additional consideration for youth mental health. Conclusions: Although one-fifth of the sample reported Studies are needed to further clarify the mechanism seeking help from a parent, adolescents experiencing underlying this association. poverty report increased formal service use perhaps due Financial Support: This study was supported by a to increased access into safety-net programs. Additionally, postdoctoral fellowship from the Canadian Institutes of adolescents with mental illness/substance abuse in the Health Research (CIHR). family showed greater use of school-based services. These adolescents may lack social capital and have PP12│Resilience and dysfunction among disproportionate mental health risk and thus depend on Iranian and Iraqi torture survivors in Finland more readily accessible school-based mental health support. To help adolescents experiencing adversity, and Sweden providing school-based services is important. Ferdinand Garoff University of Helsinki, Helsinki, Finland PP11│The timing of sleep and the mental Introduction: Even after many years, past torture is health of adolescents significantly associated with emotional distress. Previous Genevieve Gariepy, Elgar Frank trauma, lower education, as well as post-migratory factors McGill University, Montreal, Canada such as few social contacts and no occupation predict emotional distress and/or a lower health-related quality of Introduction: Recent evidence suggests that preference life (Carlsson, Mortensen, & Kastrup, 2006). This study in the timing of sleep, or chronotype, relates to adolescent compares the health and well-being, as well as health mental health. The hypothesis is that night owls struggle service utilization and the social and economic situation of more than early birds because they get less sleep, in part torture and trauma survivors with non-survivors in Finland due to early school start times. Yet few studies have and Sweden. adjusted for sleep duration and none controlled for school Methods: This presentation addresses findings from two start time. We examined the association between population-based studies conducted with immigrants chronotype and indicators of youth mental health, resident in Finland (2010-2012) and Sweden (2005). In the controlling for sleep duration and school start time. data sets men of Iranian and Iraqi origin were selected for Methods: Data were collected in the 2014 Canadian additional study as their reports indicated a significant Health Behaviour in School-Aged Children survey (29,635 prevalence of torture experiences (20-25%) and other students; ages 10-18). Chronotype was estimated using potentially traumatic events (PTEs). Both studies included the mid-cycle sleep time on weekends, corrected for catch- the Hopkins Symptom Checklist-25 (Derogatis, Lipman, up sleep. We examined scores for emotional problems Rickels, & Covi, 1974) and other measures of health and (range 0-33), emotional well-being (0-22), behavioral well-being. Other variables assessed in both studies problems (0-28) and prosocial behaviours (0-25). We included demographic data, employment status, economic analyzed data using school random-effects regressions, situation, language proficiency in Finnish/Swedish and adjusted for sleep duration, school start time, individual experiences of discrimination. and family characteristics, rurality, season, latitude, and Results: Participants in this study that reported PTEs and province. torture in particular were doing significantly worse on many Results: The average mid-sleep time was 4:11 a.m. A later indicators, compared to those not reporting any PTEs. It chronotype was associated with worse mental health must be noted however, that employment status was not scores. Each hour delay in mid-sleep was associated with impacted by past PTEs. Loss of interpersonal trust was 0.4 (95% CI 0.3, 0.5) higher point score on emotional evident in that confidence and trust in authorities and problems and 0.2 (95% CI 0.1, 0.3) on behavioral public service providers was significantly lower among

Book of Abstracts 31

torture survivors. This may in turn impact help seeking. and others due to their driving, or operating machinery in Torture survivors also reported more discrimination by general after having had too much to drink. authorities and in daily life. Conclusion: The findings of this study support previous PP14│Diurnal patterns of motor activity in evidence that torture and other PTEs are prevalent in association with mood disorders in two refugee and migrant populations and that they create a wide-ranging and long-term vulnerability to resource loss family studies that impacts social functioning, health and quality of life. Jennifer Glaus1, Lihong Cui1, Xueping Zhou1, Vadim Effective screening, continuous trust building and flexible Zipunnikov1,2, Haochang Shou1,3, Marie-Pierre service provision is necessary to address the multiple Strippoli4, Martin Preisig4, Kathleen Merikangas1 needs of migrants and refugees with experiences of severe 1Genetic Epidemiology Research Branch, Intramural Research PTEs, such as torture. Program, National Institute of Mental Health, Bethesda, MD, USA; 2Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Department of PP13│From DSM-IV to DSM-V alcohol-use Biostatistics, Epidemiology, and Informatics, University of disorders among university students from Pennsylvania Perelman School of Medicine, Philadelphia, PA, Lebanon: Epidemiological and clinical USA; 4Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University implications Hospital Lausanne, Switzerland Lilian Ghandour, Sirine Anouti American University of Beirut, Beirut, Lebanon Introduction: Growing evidence regarding the association between low physical activity and mood disorders has led A total of 1155 university students selected from 8 large to increasing application of objective mobile assessments private and public universities in Lebanon participated in of motor activity. We compared data of two family studies an anonymous self-filled survey in May 2016. Data on assessing motor activity with the same accelerometer DSM-IV and DSM-V criteria of alcohol-related disorders device. Using a novel functional data analysis framework were gathered from the 582 past-year drinkers, of which our aims were to: (1) evaluate the diurnal patterns of motor 203 (34.88%) were screened for DSM-V any alcohol-use activity (a) between subjects (subject-specific) and (b) disorders (AUD) and 377 (64.78%) for abuse/dependence within subjects (day-specific), and (2) compare these (64.6% abuse, and 8.25% dependence). Of the 203 patterns across diagnostic groups. diagnosed with DSM-V any AUD, 58% had mild, 21% Methods: The sample consisted of 69 participants from moderate, and 21% severe alcohol-related problems. Both the NIMH family study and 491 participants from the DSM-IV and DSM-V classified 199 students (34% of the Lausanne family study, both part of the Motor Activity sample) and 197 (33.8%) as having AUD-negative and Research Consortium for Health (mMARCH), a AUD-positive, respectively. Still, a total of 180 students collaborative network established to facilitate coordination (31.8%) were AUD-negative as per DSM-V, but were of procedures, analyses, and data sharing among groups positive for DSM-IV abuse (but not dependence), mostly conducting actigraphy research. Minute-to-minute activity driven by the 'hazardous use criterion'. The 6 students who counts derived from the GENEActiv device were collected were AUD-positive according to DSM-V but not DSM-IV over a 2-week period for each participant. Psychiatric had reported positively on the newly added criterion of assessment was based on structured diagnostic "craving". Of the 191 students who had a score of 1 on interviews. Functional principal component analysis DSM-V-defined AUD, only 5 (2.62%) met the DSM-IV conducted with R was used to evaluate daily motor activity criterion of 'legal problems' (excluded in DSM-V). Overall profiles, and individual principal scores were used to study percent agreement was 68% (kappa=0.41). Nonetheless, the association between (1) subject heterogeneity and (2) using a summation score for DSM-IV abuse and day-to-day variation with mood disorders. dependence criteria (range 0-11), and DSM-V any AUD as Results: The following 4 subject-specific principal the 'reference', the area under the ROC curve was 0.9895, components of motor activity were similar in both studies: and a cut-off of 2+ for DSM-IV abuse/dependence yielded (1) average daily activity 24hr-period (explaining 61% in a sensitivity and specificity of 96.55% and 98.68%, the NIMH study and 34% in the Lausanne study, of the total respectively. In this university sample of young adults, variation), (2) contrast between daytime and nighttime DSM-5 diagnostic criteria do not seem to inflate prevalence activity/sleep (explaining 18% and 15%), (3) morning rates of AUD as compared with DSM-IV. A substantial versus afternoon activity (9% and 10%), and (4) morning percentage of young adults who don't meet DSM-V criteria and afternoon peaks (explaining 3% and 9%). Our analysis of any AUD may still be a source of harm to themselves on the principal scores for PC2 showed marginally lower

Book of Abstracts 32

day-to-day variation in bipolar-II (p=0.07) and higher PC3 recruited a less healthy and younger sample, but there was for major depressive disorder (p=0.03) compared to no bias associated with "humour". The "mental fitness" ad controls. The day-specific principal components did not recruited the most healthy sample, and "wellbeing" an differ among mood disorders. older sample. The images in the trial had no influence on Conclusions: These findings suggest that differences in symptom scores but did attract a different demographic. patterns of motor activity may characterize people with There were also substantial differences in recruitment different subgroups of mood disorders. Future studies rates and cost per participant, but less so on engagement should focus on mechanisms that may inform on potential in both studies between different themes. interventions such as light therapy in order to stabilize daily Conclusion: The words used to describe and recruit to an motor activity. online study can systematically bias the mental symptom and demographic profile of participants, with effect sizes PP15 | “Mental health” isn’t what it used to larger than those found in many mental health trials. Whilst be – How labels and images systematically this can be used to better target trial recruitment it can undermine generalisability and internal validity. We bias recruitment into observational and recommend that the labels and images used be reported intervention studies in studies as they may be as important as other technical Nick Glozier1, David Milne2, Isabella Choi1, David sampling issues. Whether these biases are also seen with Johnston3, Dorian Peters1, Mark Deady3, Sam clinic, face to face, or other media recruitment is unknown Harvey4, Rafael Calvo1 but it is unlikely advertising companies are paid billions of 1University of Sydney, Sydney, Australia; 2UTS, Sydney, dollars for nothing. Australia; 3UNSW, Sydney, Australia; 4Black Dog Institute, Sydney, Australia PP16│Depression among individuals with HIV infection Introduction: Researchers spend thousands of hours and millions of dollars carefully constructing sampling frames, Sumudu Godawita, Jayadarie Ranatunga, Lalin maximising recruitment, weighting samples etc. to Fernanado minimise selection bias. Rarely do we consider how labels North Colombo Teaching Hospital, Ragama, Sri Lanka and images used can select people. We manipulated labels and images in two Facebook recruitment campaigns Introduction: Globally, 36.7 million people were living with to assess any systematic biases in the samples recruited HIV at the end of 2015.Since identification of the first HIV Methods: infected Sri Lankan in 1987, a cumulative total of 2308 of 1) Five Facebook advertisement themes ("resilience", HIV positive individuals have been reported at the end of "happiness", "strength", "mental fitness", and "mental 2015 with HIV prevalence of less than 0.01%. Depression health") were used to recruit 342 male participants to an among people living with HIV infection is reported to be online observational mental health cohort study. significant. However, psychiatric disorders are likely to be 2) An RCT of Headgear, a mobile App intended to help under detected in HIV care settings. Objectives of this reduce and prevent depressive symptoms, recruited 1079 study are to assess prevalence of depression among people through Facebook using 12 advertisements (4 individuals with HIV infection & the factors associated with themes: "resilience", "mental health", "wellbeing" and comorbid depression, reasons for delay in seeking "humour"), consisting of a short call to action (e.g. "Get treatment. mentally tough") and a description of the App, and one of Methods: This is a descriptive cross-sectional study 3 images (realistic, cartoon and phone). conducted with individuals attending STD clinic at We evaluated whether there was any demographic and Colombo North Teaching Hospital, Ragama. The symptom differences in the samples recruited from each of convenient sampling method was used. The Socio- these advertisements. demographic factors were assessed using an interviewer Results: In both studies the "mental health" advert administered questionnaire. Depression was assessed recruited the most unwell sample (significantly higher using ICD-10 classification for mental and behavioral symptoms (K6 and PSS) in the observational study, and disorders and Peradeniya depression scale. PHQ9 in the trial; and lower wellbeing (WHO-5) and Results: Eighty-one (81) seropositive individuals strength (CD-RISC-10) in both studies), but they did not participated for the study and 65.4% of them were males. differ by age or employment status. The Effect Size of the Prevalence of depressive disorder is 27.2% (n=22) and differences in symptoms was as high as 0.78 in the 23.5% (n=19) among HIV zero positive individuals observational study and 0.48 in the trial. "Happiness" according to clinical assessment and Peradeniya

Book of Abstracts 33

depression scale respectively. Depressive disorder is more Emerging Sources Citation Index, Web of Science commonly seen during initial 12-month period after Conference Proceedings, Proceedings from the diagnosis of HIV infection. Individuals with low CD4 count Psychosial Aspects of Diabetes Study Group Meetings, the (<350 mm3) report significant association with depression. Cochrane Library, ProQuest Dissertations and Theses, Depressive disorder is associated with noncompliance to and the Centre for Reviews and Dissemination. antiretroviral therapy. Majority (n=9) of the individuals who Results / Conclusion: A total of 22,062 records were are depressed found multiple reasons for not seeking assessed for inclusion from the title and abstract. Of these, treatment for depression including lack of awareness of 196 were selected and are currently being assessed for available psychiatric facility, stigma associated with HIV inclusion using the full-text. Two reviewers will extract data and poor insight into depressive illness. and perform quality assessments using ROBINS-I and the Conclusion: Prevalence of depression is similar to Cochrane tool for randomized trials for the selected texts. findings form studies in other countries. Factors The primary association for analysis will be the risk ratio of significantly associated with depression are low CD4 count incident diabetes in people with versus without depression, (<350 mm) and initial twelve months since diagnosis of HIV approximated by the odds ratio or hazard ratio when infection which indicates the importance of screening for appropriate. A random effects meta-regression will depression in the management of such patients. Poor determine the influence of the measure of depression on adherence to antiretroviral therapy is observed among this association, adjusting for study characteristics such as individuals who are depressed. This study shows that follow-up time, region, population characteristics, and future research should focus on multi center studies to study covariates. For studies that use depressive symptom assess the psychiatric morbidity and related factors in scales, we will also assess if the specific scale (ex. PHQ9, detail. CESD) contributes to heterogeneity in this association. Overall heterogeneity and publication bias will be PP17│Depression and incident diabetes: assessed using I2 tests and visual techniques. Preliminary Does the measure of depression matter? A results of this analysis will be presented and discussed. Funding: EG is supported by a Frederick Banting and systematic review and meta-regression Charles Best Canada Graduate Scholarship from the analysis Canadian Institutes of Health Research. Eva Graham1, Sonya Deschenes1, Marina Khalil1, Sofia Danna2, Norbert Schmitz1 PP18│Alcohol use and intimate partner 1McGill University, Douglas Mental Health University Institute, violence in low- and middle-income Montreal, Canada; 2Douglas Mental Health University Institute, Montreal, Canada countries: Estimating an unbiased measure of association through propensity score Introduction: Meta-analyses report that people with matching and meta-regression depression have a 32% to 60% increased risk of incident M. Claire Greene1, Wietse A. Tol1,2 diabetes. However, depression is not uniformly defined in 1Johns Hopkins Bloomberg School of Public Health, Baltimore, the literature and may refer to current or historical MD, USA; 2Peter C. Alderman Foundation, Kampala, Uganda depressive symptoms, a diagnosis of major depressive disorder using a clinical diagnostic interview, physician- Introduction: Partner alcohol use is a consistent correlate detected major depressive disorder, or antidepressant of intimate partner violence (IPV) in low- and middle- use. Previous reviews have noted that the measure of income countries (LMICs). However, the magnitude of this depression may be an important source of heterogeneity association differs across studies, which may due to in the literature. However, this hypothesis has never been contextual and methodological factors. This study aims to formally assessed or quantified. As well, prior reviews estimate an unbiased measure of the association between often included language restrictions or were limited to alcohol use and IPV in LMICs and explore sources of published literature. The objective of this meta-analysis is heterogeneity between countries. to determine whether the association between depression Methods: Nationally representative data from 114,968 and incident diabetes varies by depression measure in couples in 29 LMICs that participated in the Demographic longitudinal studies of participants aged 18+ in the and Health Surveys between 2005-2016 were included in scientific and grey literature. this analysis. Partnered women of reproductive age Methods: The following databases were searched from reported on their male partner's alcohol use and IPV inception to July 16, 2017 with no language restrictions: perpetration. We compared five methods of propensity MEDLINE, EMBASE, CINAHL, PsychInfo, Web of Science score matching and weighting using covariates from male

Book of Abstracts 34

and female interviews related to demographics, gender Methods: We used data from the Norwegian Mother and norms, reproductive health, smoking, and family history of Child Cohort Study. Pregnant women throughout Norway domestic violence. We applied the matching method that were recruited between 1999 and 2008. Information about produced the lowest standardized bias to logistic children's ADHD diagnoses was obtained from the regression models quantifying the relationship between Norwegian Patient Registry. Mothers reported symptoms alcohol use and IPV. Country-specific odds ratios were of inattention and hyperactivity/impulsivity in combined using a random effects model to estimate the questionnaires. pooled odds ratio by world region. Country-level indicators Results: Children exposed to maternal fever during of health and development were regressed on odds ratios pregnancy had increased risk of receiving an ADHD to identify characteristics that explain variability in these diagnosis. This overall association was mainly driven by estimates. associations with maternal fever in the first trimester. The Results: In fully matched samples, the adjusted odds ratio risk was particularly high for children exposed to two or describing the association between alcohol use and IPV more episodes of maternal fever in the first trimester. was 2.55 (95% CI: 2.25, 2.88). There was substantial Reports of inattention were increased for children exposed variability between countries (I2=74.5%). The region- to maternal fever in the first and, to some extent, the specific odds ratios ranged from 1.92 in Latin America and second trimester. Hyperactivity/impulsivity was only the Caribbean to 12.55 in Middle East and North Africa. weakly related to fever during pregnancy, and was not Countries with a high (>50%) prevalence of past-year trimester-specific. alcohol use among men had lower odds ratios relative to Conclusion and relevance: Maternal fever in the first part countries with mid-range prevalence estimates (25- of pregnancy was associated with ADHD in the offspring. 49.9%). The availability of substance use treatment Maternal fever was also associated with inattention services was associated with larger odds ratios. Indicators symptoms in the child. of economic and social development, alcohol policy, armed conflict and colonization history did not explain variability PP20│Trends in depression diagnoses at in the estimates. hospitalization for labor and delivery, 1999- Conclusion: Partner alcohol use is consistently associated with increased odds of IPV in LMICs, but to 2014 varying degrees across regions. While development Sarah Haight1, Jean Ko1, Nancy Byatt2, Tiffany characteristics did not explain observed variability, Moore Simas2, Cheryl Robbins1 differences in prevalence of alcohol use and availability of 1Centers for Disease Control and Prevention (CDC), Atlanta, treatment services was related to heterogeneity in these USA; 2University of Massachusetts Medical School, Worcester, estimates between countries. USA Funding: MCG is supported by the National Institute on Drug Abuse (T32DA007292, PI: R Johnson). Introduction: We describe national and state-specific trends of depression diagnoses at hospitalization for labor and delivery from 1999-2014, stratified by age and PP19│Maternal fever during pregnancy and insurance status. child ADHD: Findings from a longitudinal Methods: We analyzed national data from the Healthcare cohort study Cost and Utilization Project's Nationwide Inpatient Sample Kristin Gustavson1,2, Helga Ask1, Eivind Ystrom1,2, and state-specific data from 30 states and the District of Camilla Stoltenberg1,3, W. Ian Lipkin4, Pal Suren1, Siri Columbia (D.C.) with publicly available data from the State E. Haberg1, Per Magnus1, Gun Peggy Knudsen1, Inpatient Databases, 1999-2014. We identified depression Espen Eilertsen1, Michaeline Bresnahan4,5, Heidi diagnoses and hospitalizations for labor and delivery with International Classification of Diseases, Ninth Revision, Aase1, Siri Mjaaland1,2, Ezra S. Susser4,5, Mady Clinical Modification diagnostic and procedure codes. We 4 1,2 Hornig , Ted Reichborn-Kjennerud estimated prevalence rates of depression diagnoses at 1 2 Norwegian Institute of Public Health, Oslo, Norway; University hospitalization, stratified by age and insurance status, and of Oslo, Norway; 3University of Bergen, Norway; 4Columbia University, NY, USA; 5New York Psychiatric Institute, NY, USA calculated national and state-specific average annual percentage point change for available years of data. Introduction: Maternal fever during pregnancy is Results: Nationally, the prevalence rate of depression associated with several adverse child outcomes, but its diagnoses per 1,000 delivery hospitalizations increased significance as a risk factor for ADHD is uncertain. from 3.2 in 1999 to 26.4 in 2014 with an average annual change of 1.7% (p<0.05). Women aged 35 years

Book of Abstracts 35

(30.6/1000) and women with public insurance (29.2/1,000) Adjusted hazard ratios (HR) were computed controlling for had the highest rates of depression at hospitalization for age, sex, urbanicity, income, prior diagnosis of unspecified labor and delivery in 2014 (p<.05). The availability of state- psychosis, provider making the diagnosis, prior 12-month specific data by year ranged from 14 states in 1999 to 27 psychiatric hospitalization, and prior 12-month diagnoses states and D.C. in 2011. Of the 25 states and D.C. with of mood, anxiety, substance use, or personality disorders, 2014 data, Minnesota, Oregon, Wisconsin, and Vermont and substance-induced psychosis. Particularly vulnerable had the highest prevalence rates of depression diagnoses subgroups were identified with a classification tree. per 1,000 delivery hospitalizations (>49.0), nearly twice the Results: The cumulative risk of a diagnosis of national rate of 26.4 per 1,000 delivery schizophrenia during the follow-up (mean 4.5 years) was hospitalizations. The average annual change significantly .26, with a mean time to diagnosis of 2.0 years. A future increased in all 27 states with significant linear trends; diagnosis of schizophrenia was associated with younger Maine (1999-2002; 2006-2012), South Dakota (2007- age (HR = 0.98, 95% CI 0.98-0.99), male sex (HR = 1.40, 2014), and Vermont (2001-2014) had more than twice the 95% CI 1.21-1.62), diagnosis by psychiatrist (HR = 2.65, estimated national annual increase (>3.4%; p’s<0.05). 95% CI 2.22-3.18), and psychiatric hospitalization (HR = Conclusion: The rate of depression diagnoses at 1.27, 95% CI 1.08-1.50). A prior diagnosis of a mood or hospitalization for labor and delivery increased nationally anxiety disorder was protective (HR = 0.82, 95% CI 0.71- and in all 27 states with significant linear trends. The 0.95). From the classification tree, the highest risk group largest increases over time were seen in Maine, South consisted of those diagnosed by a psychiatrist, younger Dakota, and Vermont and the highest rates in 2014 were than 27 years, without a mood or anxiety disorder, male, seen in older maternal ages and deliveries covered by and residing in a low income neighbourhood; 61.2% of this public insurance. These data highlight a need to determine subgroup progressed to schizophrenia. if increasing rates are due to changes in screening or Conclusion: Following a diagnosis of unspecified diagnosing practices, an increase in depressive psychosis, approximately 1 in 4 individuals will receive a symptoms, or some combination of these factors. future diagnosis of schizophrenia. These findings build on available risk prediction tools for clinicians in North PP21│A population-level study of risk for a America and those practicing outside of specialized mental future schizophrenia diagnosis after an health settings. index diagnosis of unspecified psychosis in PP22│Uncovering neurodevelopmental Manitoba, Canada windows of susceptibility to internalizing Jennifer Hensel1, Mariette Chartier2, Okechukwu Ekuma2, Leonard MacWilliam2, Natalie Mota1, disorders using dentine microspatial Richard Tachere1, Chelsey McDougall2, James analyses of neurotoxic metal exposures Bolton1 Megan Horton1, Leon Hsu1, Birgit Clauss Henn2, 1University of Manitoba, Winnipeg, Canada; 2Manitoba Centre Amy Margolis3, Christine Austin1, Katherine for Health Policy, Winnipeg, Canada Svensson1, Lourdes Schnaas4, Chris Gennings1, Howard Hu5, Robert Wright1, Martha Maria Téllez- Introduction: Few population-level studies have Rojo6, Manish Arora1 evaluated risk of schizophrenia after a diagnosis of 1Icahn School of Medicine at Mount Sinai, New York, USA; unspecified psychosis. Clinical predictor tools have been 2Boston Univeristy, Boston, USA; 3Columbia Univeristy, New developed based on data from secondary or specialized York, USA; 4Institute of Perinatology, Mexico City, Mexico; mental health settings based outside of North America. A 5University of Toronto, Toronto, Canada; 6National Institute of good characterization of the risk of illness progression has Public Health, Mexico City, Mexico important health and social service planning implications. Methods: A population-level study using administrative Introduction: The toxic consequences of occupational data for all residents in Manitoba, Canada ages 13-60 metal exposures have been well characterized throughout years. The cohort consisted of individuals with an inpatient history and research findings suggest exposures adversely (ICD-10) or outpatient (ICD-9) diagnosis of unspecified impact the adult brain. The developing brain is inherently psychosis between April 1, 2007 and March 31, 2012, and more susceptible to toxic injury, yet, little is known about without any prior diagnosis of schizophrenia or related critical windows of development that are most vulnerable disorder (N=3, 289). All individuals were followed until a to adverse outcomes. Accurate, objective assessment of diagnosis of schizophrenia was recorded after the index exposure timing, especially during fetal development, is a diagnosis of unspecified psychosis or until March 31, 2015. major challenge in identifying these critical windows. Here,

Book of Abstracts 36

we describe our novel use of deciduous "baby" teeth as a WTC Health Program found that nearly 20% of responders biomarker for accurately estimating metal dose and timing developed posttraumatic stress disorder (PTSD) and 13% over the prenatal and early childhood periods. We focus on had mild-severe cognitive impairment (CI). PTSD is associations between three neurotoxic metals -- increasingly recognized as a risk factor for CI and manganese (Mn), lead (Pb) and zinc (Zn) – and behavioral Alzheimer's disease and related dementias (ADRD). Little outcomes in children. is known about mechanisms underlying this relationship Methods: We present results from 153 subjects enrolled between PTSD, CI and ADRD. The objective of this overall in a longitudinal birth cohort study in Mexico City who study was to analyze neural correlates of PTSD and CI in provided deciduous teeth. We estimated weekly prenatal WTC responders. This report provides preliminary results and postnatal Mn, Zn and Pb concentrations in teeth using comparing resting state functional connectivity between CI laser ablation-inductively coupled plasma-mass cases, PTSD cases, and controls. spectrometry (LA-ICP-MS) and measured behavior at Methods: The parent sample included 3,022 SBU WTC ages 6-16 years using the Behavior Assessment System responders. A subset of 42 responders participated in an for Children, 2nd edition (BASC-2). We used distributed lag ongoing nested case-control study with brain magnetic models and lagged weighted quantile sum regression to resonance imaging (MRI) including 8 with CI only, 12 with identify the role of individual and mixed metal exposures PTSD only and 17 with neither SCI or PTSD. A 10-minute on childhood behavioral outcomes controlling for maternal resting state functional MRI scan was acquired on a education and gestational age. Siemens 3T PET/MRI scanner and preprocessing of Results: Postnatal Mn and Zn demonstrate non-linear functional images was performed using FSL including associations with increased anxiety symptoms. At 6 motion correction. Group comparisons examined months, a 1-unit increase (unit = 1 SD of log concentration) connectivity patterns between CI vs controls and PTSD vs in Mn or Zn is associated with a 0.18-unit (unit =1 SD of controls. BASC-2 score) and 0.25-unit increase in BASC-2 anxiety Results: Preliminary analyses suggest reduced score, respectively. At 12 months, a 1-unit increase in Pb connectivity in the default mode network (DMN) and the is associated with a 0.4 unit increase in anxiety score. frontal-parietal network (FPN) in CI cases (n = 8) compared When examined as a metal mixture, we observe two to controls (n = 17) (p < 0.05). DMN connectivity in PTSD windows of susceptibility to increased anxious behaviors: subjects (n = 8) was greater than controls (n = 17) (p < the first window (0-8 months) is driven by Mn, the second 0.05). Significance did not survive correction for multiple window (8-12 months) is driven by the mixture and comparisons. dominated by Pb. A 1-unit increase in the mixture is Conclusion: These preliminary results support anticipated associated with a 0.7-unit increase in SD of anxiety score. trends overserved in the literature suggesting that CI may Conclusion: Childhood behaviors may demonstrate be associated with decreased functional connectivity in the postnatal windows of susceptibility to individual and mixed DMN and FPN and that PTSD may be associated with metal exposures. aberrant connectivity patterns in DMN. Further analyses (to be included in poster) will utilize a larger sample, PP23│Neural correlates of cognitive examine comorbid PTSD and CI, address associations impairment and posttraumatic stress with additional brain regions using seed-based approaches, and examine covariates including age, sex, disorder: Preliminary analyses of 43 World depression/anxiety, and WTC exposure. Results are Trade Center responders important for completing the long-term clinical picture of Megan Horton1, Yael Deri2, Sean Clouston2, Chrissy WTC exposure effects and have implications for brain DeLorenzo2, Candace Stewart2, Edward Merritt2, aging. Lynn Onybeke1, Victoria Wang1, Johnny Ng1, Mary Sano1, Evelyn Bromet2, Sam Gandy1, Cheuk Tang1, PP24│Factors associated with the use of Roberto Lucchini1, Benjamin Luft2 psychotherapy among adults with suicidal 1 Icahn School of Medicine at Mount Sinai, New York, USA; 2 ideation and suicide attempt Stony Brook, New York, USA 1 1 Mathilde Husky , Mathieu Revranche , Viviane 2 Introduction: World Trade Center (WTC) responders Kovess-Masfety 1 2 experienced multiple toxic and traumatic exposures during Université de Bordeaux, Bordeaux, France; Ecole des Hautes Etudes en Santé Publique, Paris, France search, rescue, and clean-up efforts. A recent study of responders at the CDC-funded Stony Brook University

Book of Abstracts 37

Introduction: The current study aims to characterize the 1Laboratory of Psychiatric Neuroscience, Australian Institute of use of psychotherapy and to identify the sociodemographic Tropical Health and Medicine, James Cook University, and clinical factors associated with the use of Townsville, Australia; 2College of Medicine and Dentistry, James psychotherapy among adults who reported suicidal Cook University, Townsville, Australia; 3Psychiatric ideation, or a prior suicide attempt, and among adults with Epidemiology and Burden of Disease Research Group, Queensland Centre for Mental Health Research, School of no lifetime suicidal thoughts or behaviors. Population Health, University of Queensland, Wacol, Methods: Data were drawn from a large 2005 cross- Queensland, Australia; 4Australian Institute of Tropical Health sectional general population survey (n=22,138) conducted and Medicine, James Cook University, Townsville, Australia; in four regions of France. Data were collected by trained 5College of Public Health, Medical and Veterinary Sciences, interviewers using a computer-assisted telephone Townsville, Australia interviewing system. The Composite International Diagnostic Interview-Short Form was used to determine Introduction: Despite the globally observed and widely DSM-IV psychiatric disorders in the previous 12 months. documented epidemiological transition that takes place in Respondents were also asked a series of questions many developing regions within the tropics, the possible regarding their use of psychotherapy over the course of emergence of neuropsychiatric disorders as a significant their lifetime, and in the previous 12 months. contributor to disease burden as dictated by the Global Results: Overall, 7.0% of adults reported having Burden of Disease 2015 study (GBD 2015) has not yet undergone psychotherapy in the course of their life, and been considered in this world region. 1.9% in the previous 12 months. Psychotherapy was Methods: We re-aggregated disability-adjusted life years provided by psychiatrists (56.6%), psychologists (28.9%), (DALYs) for individual countries into tropical and non- by psychoanalyst (11.3%). Factors associated with tropical groups. UN population estimates, projected Gross psychotherapy included gender, being separated, a higher National Income (GNI) and 2015 DALY rates for tropical level of education, and unemployment status. Among countries were applied to predict future burden estimates adults with a prior history of suicide attempt, 17.5% for neuropsychiatric and communicable disease groups up underwent psychotherapy at some point in their life, and to the year 2050. 13.2% reported multiple psychotherapies. While the Results: Our analysis of the GBD 2015 suggests that the frequency of psychotherapy sessions was greater among neuropsychiatric disease burden in tropical counties had those with a prior attempt as compared to those with no increased by 72.1% between the years 1990 and 2015 prior attempt, there was no difference in therapy duration. (Abstract Figure 1). The neuropsychiatric burden in tropical Factors associated with having undergone a countries, with respect to total DALYs in 1990, has grown psychotherapy in the previous 12 months included specific at almost twice the rate as that of the neuropsychiatric mental disorders, gender, age, education, income level, disease burden in non-tropical countries. The increase in employment status, marital status, and region of the burden of tropical communicable diseases by contrast residence. was found to be 14.4% during the same period; a Conclusion: Psychotherapy is currently not reimbursed by statistically insignificant increase. Further increases of the national social security and health benefits available to 129.0% are projected for the burden of neuropsychiatric all residents. While there currently are efforts to consider disorders in the tropics between 2015 and 2050, whereas the reimbursement of psychotherapy, few data are there is projected to only be an increase of 34.5% in the available regarding the use of psychotherapy. The present burden of tropical communicable diseases during the same study provides important insight into the use of period (Abstract Figure 2). psychotherapy in the general population and among those Conclusion: These figures call for a re-orientation of with a history of suicide attempt. health services in tropical regions so as to cater to the emerging neuropsychiatric disease burden, which is likely PP25│Neuropsychiatric disorders in the to surpass the tropical communicable disease burden by tropics: Findings from the global burden of as early as 2020. The emergence of neuropsychiatric disorders over the last two decades, and the projected disease study 2015 increase in health burden can be attributed to a range of Sarangan Ketheesan1,2, Alize Ferrari3, Fiona factors which are unique to tropical regions. These factors Charlson3, Holly Erskine3, Harvey Whiteford3, Emily may include: socioeconomic disadvantage and poverty, Callander4, Daniel Lindsay4, Maximus Berger1,5, cultural attitudes and stigma attached to mental illness, Nadine Jansen1,5, Sophia Pearson1,5, Zoltan lack of effective preventative health measures and primary Sarnyai1,4,5 health care, climate change and natural disasters, and the

Book of Abstracts 38

unique neuropsychiatric sequelae of certain neglected findings illustrate that results may differ depending on how tropical diseases. codes have changed due to coding transition. While Funding: James Cook University College of Medicine and findings cannot conclude whether observations reflect true Dentistry changes in prevalence, utilizing this approach of systematic methodology can help assess impact of ICD PP26│ ICD-9-CM to ICD-10-CM transition transition on mental health trends. among pediatric mental health diagnoses Sana Khan, Carol Yoon, Sungwoo Lim, Sze Yan Liu, PP27│Preliminary evaluation of a fidelity Marivel Davila questionnaire for first episode psychosis New York City Department of Health and Mental Hygiene, Long services Island City, USA Miriam Kinkaid1, Rebecca Fuhrer1, Ashok Malla2,3, Stephen McGowan3,4 Introduction: The United States' transition to International 1Department of Epidemiology, Biostatistics, and Occupational Classification of Diseases, Tenth Revision, Clinical Health, McGill University, Quebec, Canada; 2Department of Modification (ICD-10-CM) in 2015 impacted diagnostic Psychiatry, McGill University, Quebec, Canada; 3South West coding for pediatric mental health. It is imperative to Yorkshire Partnership NHS Foundation Trust, United Kingdom; critically examine mental health trends to assess whether 4IRIS Early Intervention in Psychosis Network changes in prevalence are true or attributed to the complex transition of 456 ICD-9-CM codes to 706 ICD-10-CM Introduction: Early intervention (EI) services for psychosis codes. We present trends in New York City (NYC) pediatric provide intensive, youth-focused, sustained treatment to mental health Emergency Department (ED) visits from people experiencing a first episode of psychosis. 'Fidelity' 2006 through 2016, stratified by three categories to refers to the degree to which a program is delivered as demonstrate how the ICD transition influenced pediatric intended; research shows substantial heterogeneity in EI mental health trends. services delivery. There are several fidelity instruments Methods: Utilizing an ICD-9-CM to ICD-10-CM crosswalk available for EI services; however, most lack evidence of from the Centers for Medicare and Medicaid Services, we reliability or validity, and cannot be applied in all research created three categories based on complexity of transition: contexts because they are based on resource intense (1) "1-to-1": one ICD-9-CM mapped to one ICD-10-CM chart audits. We conducted an evaluation of the reliability code, (2) "Many-to-1": multiple ICD-9-CM collapsed to one and validity of our recently developed fidelity questionnaire ICD-10-CM code, and (3) "1-to-Many": one ICD-9-CM that can be completed by EI staff and used in research on expanded into many ICD-10-CM codes. NY Statewide EI effectiveness. Planning and Research Cooperative System data provided Methods: A sample of nine EI teams in England ED use from 2006 to 2016 for NYC children under 21. participated in the evaluation of the 29-item fidelity Joinpoint Regression 4.0.4 calculated trends by proportion questionnaire. Two staff members, who were the most of ED visits that were mental health related by diagnoses familiar with the team's operations, independently within each category. completed the questionnaire. A third (theoretical 'gold Results: The proportion of ED visits with a primary mental standard') was completed by a member of the research health diagnosis increased significantly by 1.93% from team using EI team administrative documentation and a 2009 to 2014, then decreased significantly by 1.34% until random sample of patient medical records. Inter-rater 2016. Mood disorder ("1-to-1") ED visits increased reliability (IRR) was estimated, using percent agreement significantly by 3.25% from 2010 to 2014, then decreased and Cohen's kappa, by comparing the responses from EI significantly by 2.99% until 2016. Schizophrenia and team staff members to each other and to the 'gold psychosis ("Many-to-1") ED visits increased significantly standard'. A composite fidelity score is in development. by 1.29% from 2006 to 2013 and by 4.62% from 2013 to Results: Seventeen staff members from nine teams 2016. Substance use ("1-to-Many") ED visits increased completed the fidelity instrument. The 'gold standard' was significantly by 1.40% from 2006 to 2011, followed by a completed for eight teams. Percent agreement for items of nonsignificant trend until 2016. staff-completed questionnaires ranged from 12.5% to Conclusion: Monitoring pediatric mental health trends 100%, with 83 of the 142 item response categories requires evaluating how diagnostic coding was affected by showing agreement of 75% or more. Kappa for all ICD transition. In this analysis, "1-to-1" diagnoses mirrored individual items ranged from -0.5 to 1.0. The kappa for 46 trends in overall mental health. However, trends fluctuated of the responses indicated that there was no more for diagnoses that underwent complex transition. Such agreement (kappa=0) or less agreement (kappa<0) than

Book of Abstracts 39

expected by chance, whereas for 23 of the responses it values<.05); however, they did not differ significantly from was 0.41 or more (moderate to greater agreement). each other. Comparisons between 'gold standard' and EI-staff- Conclusions: Our results suggest that both cannabis use completed fidelity questionnaires also yielded a wide range and a positive HIV status are associated with poorer of estimates. performance-based, but not self-report, measures of Conclusions: This preliminary analysis shows evidence of everyday functioning. There was no evidence for additive reliability for some questionnaire items; however, a large adverse effects of cannabis use among HIV+ individuals. number could not be measured reliably in our evaluation. Further studies will examine whether cannabis use severity Further analyses will examine whether a composite fidelity influences these results or if specific subsets of HIV+ score and sub-scores are more reliable and therefore individuals are more vulnerable to cannabis-associated useful. deficits. This research was supported by a Canadian Institutes of Funding: R01DA033156. Health Research (CIHR) Doctoral Research Award, an ACCESS-Open Minds Studentship (CIHR), and a Michael PP29│The effect of parental drinking on Smith Foreign Study Supplement. children’s mood and anxiety problems as

young adults – A longitudinal combined PP28│The independent and combined survey and registry study effects of cannabis use and HIV on everyday Ingunn Olea Lund1, Svetlana Skurtveit1, Marte functioning Handal1, Fartein Ask Torvik1, Eivind Ystrøm2, Catalina Lopez-Quintero, Jacqueline Duperrouzel, Anne Bukten3, Jasmina Andreas Burdzovic 1 Raul Gonzalez 1The Norwegian Institute of Public Health, Oslo, Norway; 2The Florida International University, Miami, USA University of Oslo, Oslo, Norway; 3SERAF, Oslo, Norway

Introduction: Cannabis use and HIV have independently Introduction: The preliminary aims were to explore the been associated with poorer everyday functioning. Studies putative long-term associations between exposure to investigating their combined effects are scarce, despite parental drinking during childhood and mental health medical cannabis being legalized in numerous states for outcomes in early adulthood. HIV-associated symptoms. This study aims to characterize Methods: Sample: 5431 children nested within 4328 two- the independent and combined effects of cannabis use and parent families from the Nord-Trondelag Health Study HIV on daily functioning. (HUNT and Young-HUNT). The study was conducted Methods: Data were collected from 277 individuals (ages 1995-1997, when children were between 13 and 19. 18 to 60), including HIV+/cannabis users (CAN+) (n=54), Children and parents completed extensive questionnaires. HIV+/non-cannabis users (CAN-) (n=75), HIV-/CAN+ Exposure variables: Information from the questionnaires (n=71) and HIV-/CAN- (n=77). CAN+ participants reported concerning parental drinking, parental and child mental recent and regular cannabis use. Daily functioning was health, family and SES characteristics was used to identify assessed using two self-report (the Social Adjustment a preliminary set of risk factors associated with parental Scale and the Lawton and Brody - Activities of Daily Living drinking. Outcome variables: Children's mood and anxiety Scale) and two performance based (The Finances Test, problems were identified through three population- and the revised Medication Management Test) tests. Mean encompassing registries capturing: 1) primary health care scores of daily functioning tests were compared among consultations, 2) treatment in specialist health care, and 3) four HIV/CAN subgroups via ANCOVA with including dispensed prescription drugs. Information was available potential confounders (i.e., age, alcohol use, mental from 2004 and onwards, capturing mood/anxiety outcomes health). All post hoc pair-wise comparisons of between in early adulthood. Analytical approach: A simple count group differences were carried out with the Fisher-Hayter variable captured the individual participant's appearance in test. 0-3 registries. Preliminary univariate zero-inflated Poisson Results: Significant differences in the mean score of the (ZIP) models explored the association between identified Finances Test (p<0.01), and the revised Medication risk factors and mental health problems in early adulthood. Management Test (p<0.01) were observed between the Subsequent, analyses will explore the associations groups. Compared to HIV-/CAN- individuals, each of the between more complex patterns of early familial risk and other three subgroups showed lower functioning in the mental health problems in early adulthood. financial and medication management tests (p- Results: The preliminary simple ZIP models revealed no increased risk associated with children's future mental

Book of Abstracts 40

health outcomes as a function of any maternal or paternal to be associated with onset of depression (RR: 1.5; 95%CI: alcohol-use variables as assessed during childhood, i.e. 1.1-2.18). drinking amount and frequency; examination of putative Conclusions: Preliminary findings suggest that there is a high-risk categories and critical cut-off points will be relationship between negative household African adults. conducted in the next analytical step. However, as would Further interrogation of the data will be conducted be expected, mental health outcomes in early adulthood including adjusting for individual level covariates. were significantly associated with children's own and their parent's mental health problems as assessed during PP31│Mind the gap: Alcohol use screening childhood. Overall, children who had elevated scores on a depression scale, or had both parents with high depression and discussions with care providers among scores, had 15-18% increased risk of registry-related Asian adults in the United States outcome. Additional analyses will utilize more complex Silvia S. Martins1, Pia M. Mauro1, Jeremy C. Kane2 classification approaches in order to identify meaningful 1Columbia University, New York, USA; 2Johns Hopkins patterns of early familial risk (i.e., unique combinations of University, Baltimore MD, USA parental drinking and mental health problems), and their putative contribution to subsequent mental health Introduction: Although alcohol use prevalence increased problems among children from such families. by nearly 30% among Asians between 2002 and 2013, in Conclusion: The results will be discussed. 2014 they had lower alcohol use screening in primary care settings than non-Hispanic (NH) Whites. We estimated frequency of alcohol use screening at healthcare visits PP30│The relationship between negative among Asians in the U.S. and tested differences in household level events and adverse health screening/discussions by alcohol use disorder (AUD) and outcomes in South African adults: Evidence other racial/ethnic groups. from the National Income Dynamics Study Methods: We pooled data from the 2015-2016 National Survey on Drug Use and Health. Among Asian adults (NIDS) reporting past-year alcohol use, we estimated weighted Sumaya Mall, Lumbwe Chola frequencies of alcohol screening (i.e., no screening, University of the Witwatersrand, Johannesburg, South Africa screened only, discussions with provider) in any past-year healthcare encounter. We calculated frequencies of the Background: Research suggests that there is a content of the discussion and whether a brief intervention relationship between negative household events (e.g. loss (i.e., advice) or treatment information was provided. of employment of or death of a family member) and Multinomial logistic regressions estimated associations adverse health outcomes: hypertension, diabetes and between alcohol use screening/discussions (ref: no depression. We aim to examine the relationship between screening/discussion) by race/ethnicity (NH White, NH such events at household level and adverse health Black, Hispanic, Multiple, NH Asian). Weighted logistic outcomes in individuals in a longitudinal study of South regression estimated odds of getting advice to cut down or African adults. alcohol treatment information by race/ethnicity. Weighted Methods: We analysed data from the National Income models adjusted for socio-demographics and past-year Dynamics Study (NIDS), a national panel survey consisting mental illness. of four waves of data collected between 2008 and 2015. Results: Among Asian adults who reported past-year The probability that negative household events occurring alcohol use, 24.5% reported no alcohol use screening at a during Wave 1 are associated with individual adverse healthcare visit, 24.3% were screened but had no health effects recorded at Wave 4 was modelled using discussion with their provider, and 51.2% discussed Stata's generalized linear latent and mixed models alcohol use. Of all reporting discussions, 69.1% and 73.0% (GLLAMM) feature, specifying the multinomial logit link. discussed quantity and frequency of use, respectively, Results: Preliminary results suggest that serious illness or 13.2% discussed problems associated with their drinking, injury of a household member (3.52%) destruction of 4.1% were provided brief advice on cutting down on use, property (1.76%) and principal breadwinner losing their job and 2.1% were offered alcohol treatment information. were the most prominent (2.52%) negative household Asians had significantly lower adjusted relative odds of events (n=16,838 individuals). About 12% of the alcohol screening only (p's>0.01) and discussions respondents had high blood pressure, 3% had diabetes (p's>0.05) than each of the other racial/ethnic groups. Only and the mean depression score was 4.8. Unadjusted 1 in 14 Asians with an AUD received advice to cut down or effects suggest that negative household events appeared treatment information from their provider; odds of getting

Book of Abstracts 41

this advice was two times higher for non-Hispanic Whites calculated each of the studied years incident subjects' with an AUD (aOR=2.34[1.09-5.02]). median age in years. Conclusion: Findings highlight a gap in alcohol screening Results: A total 27,613 new cases of schizophrenia were and discussions with providers among Asian Americans identified in hospital admissions in Spain during the 2009- relative to other racial/ethnic groups, including people with 2013 period. The crude incidence rate was 23 cases per AUD. As Asians are the fastest growing racial/ethnic group 100,000 person-years, being double in men (31 cases per in the US, interventions tailored to increase clinician 100,000 person-years) than in women (15 cases per discussions and disseminate treatment information to this 100,000 person-years). The median age at diagnosis was heterogeneous group are needed. above 38 years-old [interquartile range: 31, 46]. Support: L30DA042436 (Mauro), R01DA037866 (Martins) Conclusion: In line with the literature, estimates of schizophrenia incidence and age of diagnosis arising from PP32│Incidence of first-admitted ELR are higher than those reported in first-contact designs. Indeed, our first-admittance approach probably schizophrenia in Spain between years 2009 underestimates the actual figure: during the 1980's Spain and 2013: Results from a nationwide register underwent a psychiatric reform that lead to a decrease in of inpatient cases the point-prevalence of admissions due to schizophrenia. Gonzalo Martínez-Alés1,2, Teresa López-Cuadrado2,3, Future studies should include diagnoses from outpatient Franco Mascayano4, María Fe Bravo-Ortiz1,2, devices and ascertain rate trends over a longer period of Carmen Bouza5 time. 1La Paz University Hospital, Madrid, Spain; 2School of Medicine, Autonomous University of Madrid, Madrid, Spain; 3National PP33│Implementing a recovery-oriented Centre for Epidemiology, Carlos III Institute of Health, Madrid, intervention to address stigma towards Spain; 4Mailman School of Public Health, Columbia University, NY, USA; 5Health-Care Technology Assessment Agency, Carlos mental disorders: A randomized controlled III Institute of Health, Madrid, Spain trial Franco Mascayano, Nicholas Vivio, Thamara Tapia, Introduction: Since the World Health Organization Ten- Ezra Susser Country study, incidence of schizophrenia is commonly Columbia University, New York, USA estimated through a sampling frame that screens every subject seeking mental health treatment for the first time. Introduction: Only a few anti-stigma interventions have Recent evidence following a variant of the first-contact been implemented in Latin America. We conducted a method suggests that the incidence of schizophrenia in randomized controlled trial of a recovery-oriented Spain may be around 15 cases per 100,000 person-years, intervention based on narrative therapy to address self- with median age ranging between 26 and 33 y-o. However, stigma among people with severe mental illness. The studies using data from electronic longitudinal registers primary outcome was self-stigma; secondary outcomes (ELRs) have yielded a higher incidence, with more cases included quality of life, psychopathology, and perceived in older age intervals. Our objective is to estimate the stigma. incidence of first-admitted schizophrenia in Spain using Methods: Participants were men and women, 20 to 60 ELRs. years of age, with a diagnosis of severe mental disorder Methods: We performed a population-based retrospective according to ICD-10 criteria (e.g., schizophrenia, study using data from the nationwide Minimum Basic Data schizoaffective disorder, bipolar disorder and major Set (MBDS) of discharged patients. We analyzed depressive episode with psychotic symptoms). Seventy- admissions due to a diagnosis of schizophrenia (ICD-9 six individuals were recruited and allocated to either CM: 295.XX) between years 2004 and 2013. To estimate intervention group (n=38) or control group (n=38). The the incidence of new cases, we selected all Spanish intervention consisted of 10 sessions, delivered weekly to residents between 20 and 54 y-o who were discharged a group of 7 to 10 participants. It had three core with a main diagnosis of schizophrenia between 2009 and components: 1) recovery orientation, focused on hope, 2013. We excluded those with a prior admission due to the self-determination, revelation and empowerment; 2) same cause or with schizophrenia as a secondary socioconstructivist psychoeducation, based on individual diagnosis, aiming to capture the first hospitalization where or shared experiences that can be obtained through group the diagnosis was established. We obtained crude discussions; and 3) narrative therapy, which emphasizes incidence rates per 100,000 person-years. We also the deconstruction (stigma) and reconstruction (empowerment) of users' stories by employing therapeutic

Book of Abstracts 42

techniques such as the "tree of life". Assessments were Methods: The study sample included 4,975 Swiss men performed at baseline (T0), three months (T1), and six (mean age 20±1.2 years) who participated in the baseline months (T2) after randomization. Measures included and 15-month follow-up assessments of the Cohort Study Internalized Stigma of Mental Illness Scale (ISMI), Link's on Substance Use Risk Factors. We examined the Perceived Devaluation Discrimination Scale (PDD), Seville association between of ADHD, as assessed at baseline Quality of Life Questionnaire (SQLQ) and the Positive and using Adult ADHD Self-Report Scale Screener (ASRS- Negative Syndrome Scale (PANSS). Paired t-test and v1.1), and emerging adulthood (psychological states and general linear models (GLM) were performed. Missin data social roles of adulthood), the risky use of alcohol, nicotine Results: ISMI mean scores were similar at baseline but and cannabis and their corresponding use disorders lower at T1 (t = -5.23; p < 0.001) and T2 (t = -4.53; p < (alcohol use disorder, cannabis use disorder and nicotine 0.002) in the intervention group compared to the control use disorder) at follow-up. In addition, the association group. GLM models showed a positive interaction between between ADHD and the course of outcomes (i.e., absence, group and time point assessment (F = 8.24; p<0.001) initiation, maturing out, persistence) over 15 months. All controlling by sex, age, employment and education. No analyses were adjusted for socio-demographics and co- significant differences between groups were seen on morbidity. Perceived stigma (PDD), Psychopathology (PANSS) and Results: ADHD symptoms severity was associated with a Quality of Life (SQLQ). decreased number of adulthood markers and increased Conclusions: Here we describe promising findings from a psychological states of emerging adulthood. Young people novel recovery-oriented intervention to reduce self-stigma. with high ADHD symptoms severity also had a reduce This is the first clinical trial of such a program in Latin number of adulthood markers over time. Men with ADHD America. Future research is needed to determine its were more likely to exhibit persistent risky alcohol and effectiveness and scale up in mental health services. nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively associated with alcohol PP34│Adult attention-deficit /hyperactivity use disorder(AUD) and negatively associated with disorder: Association with transition to cannabis use disorder (CUD) at follow-up, but not with nicotine use disorder (NUD). For all substance use adulthood and problematic substance use disorders, ADHD had a positive association with persistent Meichun Mohler-Kuo1, Natalia Estévez-Lamorte2, use and maturing out. Comparing these two trajectories Stéphanie Baggio3, Gerhard Gmel4 revealed that early onset of alcohol use distinguished 1University of Applied Sciences and Arts, Western Switzerland between persistence and maturing out of AUD, while the School of Nursing Sciences, La Source, Lausanne, Switzerland; course of NUD and CUD were related to ADHD symptoms 2Swiss Research Institute for Public Health and Addiction, and SUD severity at baseline. 3 Zurich, Switzerland; Geneva University Hospitals and University Conclusions: ADHD symptoms severity may delay the of Geneva, Geneva, Switzerland; 4Alcohol Treatment Centre, transition to adulthood. Men with ADHD symptoms are Lausanne University Hospital CHUV, Lausanne, Switzerland more likely to exhibit persistent problematic substance use Background: Attention-Deficit/Hyperactivity Disorder patterns already shown in early 20s. Substance-specific (ADHD) is worldwide one of the most prevalent psychiatric prevention strategies, particularly implemented before conditions in children. Contrary to an earlier assumption early adulthood, may be crucial to reducing the that ADHD only occurs during childhood and adolescence, development and persistence of pathological patterns in more recent research has demonstrated that roughly 65% such individuals. of children or adolescents diagnosed with ADHD will continue to suffer from ADHD symptoms in adulthood. In PP35│Combining green cards, telephone particular, Adults with ADHD symptoms are at increased calls and postcards into an intervention risk of adverse consequences, including unfavorable algorithm to reduce suicide reattempt occupational, economic, and social consequences, and psychiatric disorders such as substance use and addition. (ALGOS): An as-treated analysis of a The present study aims to investigate whether adult randomized controlled trial attention-deficit/hyperactivity disorder (ADHD) is Antoine Messiah1, Charles-Edouard Notredame2, associated with transition to adulthoods and risky Anne-Laure Demarty2, Stéphane Duhem2, substance use and substance use disorders (SUDs). We Guillaume Vaiva2 will further examine its impact on the course of these 1INSERM, Villejuif, France; 2Hôpital Fontan & Universités de problematic substance use patterns. Lille, Lille, France

Book of Abstracts 43

associations between DSM-5 PTSD and engagement in Background: Brief contact interventions (BCIs) might be three sexual behaviors - the presence of a sexually reliable suicide prevention strategies. BCI efficacy trials, transmitted disease/infection [STD/STI], infrequency of however, gave equivocal results. In order to elicit condom use, and sex with a known injection drug user. intervention strengths and weaknesses, an As Treated Methods: Data came from the National Epidemiologic analysis strategy was applied to the ALGOS trial, a Survey on Alcohol and Related Conditions - III (NESARC- composite BCI that gave inconsistent results when III: 2012-2013), a nationally representative survey of non- analyzed with Intention-To-Treat strategy. institutionalized U.S. adults aged 18 years and older. Methods: ALGOS was a randomized controlled trial Sexual behaviors and trauma exposure were assessed via conducted in 23 French hospitals. Suicide attempters were self-report, and DSM-5 PTSD was assessed using a randomly assigned to either the intervention group (Algos) structured interview. Logistic and multinomial regression or the control group (Treatment as usual TAU). Algos first analyses examined associations between PTSD, PTSD attempters received crisis cards; Algos non-first attempters symptom clusters, and traumatic event type, and each received a phone call, and post-cards if the call could not sexual behavior. be completed, or if the participant was in crisis and/or non- Results: Lifetime PTSD was associated with an increased compliant with treatment. AT analysis accounted for the likelihood of having a past year STD/STI and having sex actual intervention received, regardless of the group with a known injection drug user (adjusted odds ratio patients belonged to. [AOR] range 1.96-2.22). A greater number of symptoms Results: 1,040 patients were recruited and randomized from the negative cognitions and mood PTSD cluster was into two groups of N=520, from which 53 withdrew particularly associated with increased odds of a past year participation; 15 were excluded after inclusion/exclusion STD/STI. Reporting of child maltreatment, adult sexual criteria reassessment. Algos first attempters were less assault, assaultive violence, and 'other' trauma as one's likely to reiterate suicide attempt (SA) than their TAU worst event was associated with increased odds of a past counterparts at 6 and 13-14 months (RR [95% CI]: 0.46 year STD/STI (AOR range 1.74-4.75), while child [0.25-0.85] and 0.50 [0.31-0.81] respectively). Algos non- maltreatment and adult sexual assault were associated first attempters had similar SA rates as their TAU with using condoms "never/almost never" in the past 12 counterparts at 6 and 13-14 months (RR [95% CI]: 0.84 months (AOR range 1.43-1.72). [0.57-1.25] and 1.00 [0.73-1.37] respectively). SA rates Conclusion: The current study demonstrated an were dissimilar within the Algos non-first attempter group. association between certain trauma exposures, PTSD, Conclusions: Crisis cards were efficacious to prevent SA and a higher likelihood of engagement in sexual risk reiteration among first-time attempters. Phone calls were behaviors. Clinicians working with individuals with PTSD not efficacious among multi-attempters, but were symptoms, particularly those who have been exposed to informative of their SA reattempt risk, thus a key interpersonal trauma, should screen for the presence of component of future interventions. engagement in these practices.

PP36│Associations between trauma PP37│The relative prevalence of mental exposure, DSM-5 posttraumatic stress disorders in the pregnancy and postpartum disorder, and engagement in sexual risk periods: A population-based study behaviors in a nationally representative Natalie Mota, Mariette Chartier, Okechukwu Ekuma, sample Yao Nie, Jennifer Hensel, Leonard MacWilliam, Natalie Mota, Sarah Turner, Natalie Taillieu, Isabel Chelsey McDougall, James Bolton Garces, Kirby Magid, Japandeep Sethi, Shannon University of Manitoba, Winnipeg, Canada

Struck, Renee El-Gabalawy, Tracie Afifi Introduction: Most population-based studies examining University of Manitoba, Winnipeg, Canada the prevalence of perinatal mental disorders have focused

on select disorders and have not included a control group Introduction: Previous work examining the link between of non-perinatal women. We compared the prevalence of posttraumatic stress disorder (PTSD) and sexual risk mental disorders and suicide attempts within the same behaviour has mostly been conducted in clinical or college women across the pre-pregnancy, pregnancy and samples, has used DSM-IV PTSD, and has not examined postpartum periods, and between this perinatal cohort and the independent impact of individual PTSD symptom a non-perinatal control group using population-based, clusters on sexual risk. The current study examined administrative data.

Book of Abstracts 44

Methods: Data came from the Manitoba Centre for Health a clinical diagnosis of ADHD. This study investigated sex Policy, an administrative data repository for residents in differences in the severity and presentation of ADHD Manitoba, Canada. A perinatal cohort consisted of women symptoms, conduct problems and learning problems in aged 18-45 who experienced at least one pregnancy males and females with and without clinically diagnosed ending in live birth between April 1, 2011 and March 31, ADHD. We then investigated whether the predictive 2014 (n=45,362). Pre-pregnancy, pregnancy and associations of these symptom domains on being postpartum periods were defined as 40-week intervals diagnosed and treated for ADHD differed in males and representing mean gestation. The control cohort consisted females. of age-matched women who were never pregnant during Methods: Parents of 19,804 twins (50.64% male) from the the three-year period (n=139,705). Mental disorder Swedish population completed dimensional assessments diagnoses were determined using physician-diagnoses. of ADHD symptoms and co-occurring traits (conduct and Generalized estimating equation modelling was employed learning problems) when children were aged 9 years old. to compare relative risks of mental disorders between Children from this population sample were linked to Patient groups adjusted (aRR) for demographic factors, parity, and Register data on clinical ADHD diagnosis and medication mental health history. prescriptions. Results: Within the perinatal cohort, pregnancy was Results: At the population level, males had higher scores associated with a lower risk of a diagnosed mood and for all symptom domains (inattention, anxiety disorder, substance use disorder, and suicide hyperactivity/impulsivity, conduct, and learning problems) attempt relative to pre-pregnancy (aRR range 0.21-0.82). compared to females, but similar severity was seen in There was a higher risk of being diagnosed with a clinically diagnosed males and females. Symptom severity psychotic disorder in postpartum compared to pre- for all domains increased the likelihood of receiving an pregnancy (aRR 1.76, 95% CI 1.32-2.36), but postpartum ADHD diagnosis in both males and females. Prediction was also associated with a lower risk of a mood and analyses revealed significant sex-by-symptom interactions anxiety disorder and a suicide attempt. Compared to on diagnostic and treatment status for postpartum, pregnancy was associated with a lower risk of hyperactivity/impulsivity and conduct problems. In all mental disorders and suicide attempt (aRR range 0.44- females, these behaviours were stronger predictors of 0.88). Relative to the control group of non-pregnant clinical diagnosis (hyperactivity/impulsivity: OR: 1.08, 95% women, pregnant women showed a lower risk of all CI: 1.01, 1.15; conduct: OR: 1.43, 95% CI: 1.09, 1.87), and outcomes (aRR 0.25-0.82), while women in the postpartum prescription of pharmacological treatment period had a lower risk of a mood and anxiety disorder, (hyperactivity/impulsivity: OR: 1.08, 95% CI: 1.01, 1.15; psychotic disorder, and suicide attempt (aRR 0.58-0.93). conduct: OR: 1.43, 95% CI: 1.09, 1.87). Conclusion: Compared to a non-pregnant period, the risk Conclusions: Females with ADHD may be more easily of a diagnosed mental disorder is reduced during missed in the ADHD diagnostic process and less likely to pregnancy and in postpartum. Pregnancy may be be prescribed medication unless they have prominent protective against mental disorders, or may lead to less externalising problems. help-seeking due to competing priorities. There is also an apparent increased risk of psychosis during postpartum PP39│Common mental disorders in the that requires early identification and rapid access to second decade after genocide intervention. 1,2,3 1 Richard Neugebauer , Joanna Pozen , Joseph Ntaganira4, Vincent Sezibera5, Maggie Zraly6, Kinga PP38│Sex differences in predicting ADHD Fodor7 clinical diagnosis and pharmacological 1Department of Psychiatry, College of Physicians and Surgeons, treatment Faculty of Medicine, Columbia University, New York, USA; Florence Mowlem1, Mina Rydell2, Joanna Martin2, 2Department of Epidemiology, Mailman School of Public Health, Paul Lichtenstein2, Philip Asherson1, Henrik Larsson2 Faculty of Medicine, Columbia University, New York, USA; 3Division of Epidemiology, NYS Psychiatric Institute, New York, 1King's College London, London, United Kingdom; 2Karolinska USA; 4Department of Epidemiology and Biostatistics, School of Institutet, Stockholm, Sweden Public Health, National University of Rwanda, Kigali, Rwanda; 5Department of Clinical Psychology, Faculty of Medicine, Background: In youth, ADHD is more commonly National University of Rwanda, Kigali, Rwanda; 6Department of diagnosed in males than females, but higher male-to- Anthropology, Utah State University, Utah, USA; 7Department of female ratios are found in clinical versus population-based Psychology, Semmelweis Egyetem, Budapest, Hungary samples; suggesting a sex bias in the process of receiving

Book of Abstracts 45

Context: Brutal civil wars and genocide are endemic in the Harvard T. H. Chan School of Public Health, Boston, global south. However, studies of the scope and trajectory Massachusetts, USA; 3 Channing Division of Network Medicine, of the mental health and disability consequences of such Department of Medicine, Brigham and Women's Hospital, conflicts are rare. Boston, Massachusetts, USA; 4Center for Community-Based Objective: Seventeen years after the Rwandan Genocide Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; 5School of Public Health, Hunter College against the Tutsi, to estimate prevalence of probable and CUNY, New York, New York, USA Posttraumatic Stress Disorder (PTSD), Major Depressive Episodes (MDE) impaired social and cognitive functioning. Introduction: Social movements could have a profound Design, Setting, Participants: Cluster random survey; impact on population mental health - yet their mental health 504 adults from 46 villages, February-March 2011. consequences remain sparsely documented. We sought to Interviewers clinically trained. examine the longitudinal patterns and predictors of Main Outcome Measures: Probable PTSD (PCL depression trajectories before, during, and after the 2014 Checklist); MDE (depression module, Mini International "Occupy Central/Umbrella Movement" (OCUM) in Hong Neuropsychiatric Interview); Cognitive Impairment Kong. (subscale of WHO -Disability Assessment Scale); Methods: Prospective study of 1,170 adults randomly social/emotional functioning (Short Form- Health Survey sampled from the population-representative FAMILY 36.). Adjustment for sampling design and potential Cohort. We administered interviews at six time points from confounders. March 2009 to November 2015: twice each before, during, Results: Participation rate, 96%. Participants, 40%, below and after OCUM. The Patient Health Questionnaire-9 age 35; 77%, female; 20%, no schooling. Overall PTSD (PHQ-9) was used to assess depressive symptoms and rate 23.90 (95%CI 18.21-29.58); among persons heavily probable major depression (PHQ ≥ 10). We investigated exposed, 64%. The overall MDE rate was 29.94% (95% CI pre-event and time-varying predictors of depressive 24.62-35.26); among highly exposed individuals, 71%. symptoms, including socio-demographics, general health Higher incomes and possession of material assets were status, resilience, family support, family harmony, and associated with markedly reduced odds of MDE, e.g., odds neighbourhood cohesion. for cell phone users was 60% below that of individuals Results: Four trajectories were identified: "resistant" without a phone (AOR=0.39 95% CI 0.20-0.73). (22·6% of sample), "resilient" (37·0%), "mild depressive Individuals with MDE or PTSD alone and especially symptoms" (32·5%), and "persistent moderate depression" comorbid individuals had significantly greater odds of (8·0%). Baseline predictors that appeared to protect impaired cognitive, social and emotional functioning as against "persistent moderate depression" included higher compared with persons free of both conditions. For household income (OR 0·18, 95% CI 0·06-0·56), greater cognitive impairment the AOR for persons comorbid for the psychological resilience (OR 0·62, 95% CI 0·48-0·80), two disorders was 4.25 (95%CI 1.78-10.15) fold that of more family harmony (OR 0·68, 95% CI 0·54-0·86), higher persons free of both disorders. family support (OR 0·80, 95% CI 0·69-0·92), better self- Conclusions: Almost two decades after the Genocide, a rated health (OR 0·30, 95% CI 0·17-0·55), and fewer substantial proportion of Rwandan adults suffer from MDE depressive symptoms (OR 0·59, 95% CI 0·44-0·79). and PTSD with rates strongly associated with genocidal Conclusion: Depression trajectories following a major violence. Two prior studies conducted in 2002 and 2009 protest were comparable to those in the wake of natural afford no evidence of PTSD or of MDE rate decline. The disasters or terrorist attacks. Health care professionals prominence of depression and the persistence of probable should be vigilant of the mental health consequences PTSD should inform planning of mental health services during and after social movements, particularly among and interventions. individuals lacking social support. Source of funding: The establishment of the original PP40│Evolution of depression before, cohort was supported by the Hong Kong Jockey Club during and after a major protest Charities Trust from 2007 to 2014. Michael Yuxuan Ni1, Tom Kung Leung Li1, Herbert Hei Man Pang1, Brandford Ho Yeung Chan1, Ichiro PP41│A sibling study of child neglect and Kawachi2,3, Kasisomayajula Viswanath 2,4, Catherine depressive symptoms in adulthood: Mary Schooling 1,5, Gabriel Matthew Leung1 Evidence from the FAMILY Cohort 1School of Public Health, Li Ka Shing Faculty of Medicine, The Michael Yuxuan Ni, Felix Chi Kong Cheung, Gabriel University of Hong Kong, Hong Kong Special Administrative Region, China; 2Department of Social & Behavioral Sciences, Matthew Leung

Book of Abstracts 46

School of Public Health, Li Ka Shing Faculty of Medicine, The Christine Leong1, Geoffrey Konrad2, James Bolton3, University of Hong Kong, Hong Kong Special Administrative Heather Prior4, Leonard McWilliam4, Okechukwu Region, China Ekuma4, Nathan C. Nickel5

1PhD, College of Pharmacy, University of Manitoba, Winnipeg, Introduction: Studies have suggested that the mental Canada; 2MD, College of Medicine, University of Manitoba, health consequences of child neglect may be comparable Winnipeg, Canada; 3MD, Department of Psychiatry, College of to physical and emotional abuse. However, these findings Medicine, University of Manitoba, Winnipeg, Canada; 4MSc, are susceptible to confounding by childhood environment Manitoba Centre for Health Policy, University of Manitoba, and potential genetic disposition. As sibling studies control Winnipeg, Canada; 5PhD, Department of Community Health for confounding from shared measured and unmeasured Sciences, University of Manitoba, Winnipeg, Canada confounders, we therefore sought to examine the association between child neglect and depressive Introduction: Alcohol use disorders (AUDs) are symptoms using a sibling fixed effects design. associated with mental and physical health comorbidities Methods: 1,042 participants aged  18 years (482 sibling as well as compromised quality of life. Several prescription groups) from the FAMILY Cohort in Hong Kong were drugs exist which are aimed at treating these AUDs. administered a child neglect scale including items on However, these drugs are rarely prescribed. Moreover, health, clothing, food, education and safe living conditions. little is known about the mental health comorbidities nor the Depressive symptoms were assessed using the Patient patterns of pharmacotherapy used to treat these Health Questionnaire-9. Multilevel hurdle models individuals. predicting the presence and severity of depressive Methods: Our objective was to describe the clinical mental symptoms from child neglect were fitted. health characteristics of those individuals with an AUD who Results: 37.1% of adults reported childhood neglect. received a prescription for acamprosate, naltrexone, or Within-sibling effects of child neglect were not associated disulfiram – prescription drugs used to help manage with the presence (adjusted OR=1.03, 95% CI 0.61 to 1.75) withdrawals or cravings for alcohol – and to identify the or severity of depressive symptoms (adjusted IRR=1.15, medical specialty most likely to prescribe these 95% CI 0.89 to 1.48), adjusting for non-shared factors medications. We used total population administrative (age, sex, nativity and parental occupation at age 10). health data to identify treatment naive individuals with an Between-sibling effects of child neglect were also not AUD (i.e., with a mental and/or physical health diagnosis associated with the presence (adjusted OR=0.75, 95% CI due to harmful alcohol consumption without a prior 0.49 to 1.48) or severity of depressive symptoms (adjusted prescription for a drug used to treat an AUD) who were IRR=1.17, 95% CI 0.92 to 1.48). eligible to receive acamprosate, naltrexone, or disulfiram, Conclusion: The sibling fixed effects model did not find an April 1, 1990 and March 31, 2015. Individuals with a association between child neglect and depressive prescription dispensed for these drugs (users) were age- symptoms. Future studies should account for potential and sex-matched to individuals with an AUD who did not confounding influences from the childhood environment, have a prescription dispensed (non-users). T-tests and chi- examine whether associations might be contextually square tests were used to identify statistically significant specific and the role of shared mediators and colliders in a differences between the two groups. sibling study. Results: (125 word limit – at 96): We identified 53,556 Source of funding: The establishment of the original individuals with an AUD using total-population data. 493 cohort was supported by the Hong Kong Jockey Club (0.92%) received a prescription for acamprosate, Charities Trust from 2007 to 2014. Further support naltrexone, or disulfiram between April 1, 1996 and March provided by a grant from the Research Grants Council 31, 2015. Users were 1.60 times as likely to have a General Research Fund (Ref. No.: 17633216). comorbid mood or anxiety related diagnosis. In the one year prior to their AUD diagnosis, 75% of users and 54% PP42│Mental health and pharmaceutical of non-users had a mental health related ambulatory visit. Additionally, 16.53% of users and 11.35% of non-users characteristics of individuals with a were dispensed a selective serotonin reuptake inhibitor, a diagnosed alcohol use disorder: A class of antidepressant, and 14.60% of users and 5.57% retrospective cohort study using linked of non-users were dispensed sedatives and anti-anxiety administrative data medications. Finally, the majority of dispensed prescriptions for an AUD came from general practitioners from urban centers (53.55%), followed by psychiatrists (22.31%).

Book of Abstracts 47

Conclusion: Drug therapies to aid in the recovery from service contacts the year prior to diagnosis followed by AUD are being underutilized. Diagnosis of and treatment continued elevated use for 20 years following diagnosis. for mental health disorders is more common among those The same pattern was observed in ED visit rates with a dispensed these medications. Programs that study significant spike in ED visits the year before diagnosis clinicians’ use of AUD-targeted drug therapies should be followed by elevated use for 20 years. Among the other considered, while psychiatric services in addiction care health service use indicators, there was a spike in service require significant improvement. use corresponding with the year of diagnosis followed by 20 years of elevated healthcare use. PP43│Patterns of health and social service Conclusion: Individuals with an AUD use the greatest use associated with alcohol use disorders: amount of social services the year prior to receiving an AUD diagnosis; coordinating mental health strategies with A total-population, retrospective cohort social service providers may offer a means to identify study using linked administrative data individuals with an AUD earlier. Upstream efforts are Nathan C. Nickel1, James Bolton2, Okechukwu required to mitigate the long-lasting outcomes associated Ekuma3, Leonard McWilliam3, Heather Prior3, with AUDs. Christine Leong4, Geoffrey Konrad5 1Department of Community Health Sciences, University of PP44│Return to work in individuals with Manitoba, Winnipeg, MB Canada; 2Department of Psychiatry, common mental illness: A systematic review College of Medicine, University of Manitoba, Winnipeg, MB Canada; 3Manitoba Centre for Health Policy, University of and meta-analysis of prognostic factors and Manitoba, Winnipeg, MB Canada; 4College of Pharmacy, interventions University of Manitoba, Winnipeg, MB Canada; 5College of Yeshambel T. Nigatu1, JianLi Wang1,2 Medicine, University of Manitoba, Winnipeg, MB Canada 1Institute of Mental Health Research, University of Ottawa, Ottawa, Canada; 2School of Epidemiology and Public Health, Introduction: While alcohol use disorders (AUDs) are Faculty of Medicine, University of Ottawa, Ottawa, Canada associated with mental health comorbidities, little research has documented the long-term impact of AUDs on health Introduction: Mental illness in the workplace is an and social services use. emerging challenge across the globe. Work disability due Methods: We aimed to identify the health and social to common mental disorders (CMDs) including depression service use associated with having a diagnosed AUD. We and anxiety disorders is increasingly challenging in many used linkable administrative data from the Manitoba countries. In Canada, CMDs accounted for 30% of short Population Research Data Repository, which houses and long-term disability claims. Primarily, return to work individual-level information on the health and social (RTW) is a goal for these beneficiaries to avoid negative services used by virtually all Manitobans. We identified consequences. However, there is little evidence regarding AUDs using ICD-9/10-CA codes for conditions due to the effectiveness of the available interventions for RTW harmful alcohol use: 1990 to 2015. Those with an AUD and modifiable factors for RTW in mental health field. were matched to a comparison group (1:3) based on sex, Hence, the objectives of this review were to identify age, and postal code of residence at time of diagnosis. We prognostic factors for RTW and examine the effectiveness linked individuals’ health, social services, and justice of existing interventions for RTW in workers with CMDs. records to identify outcomes associated with AUDs. Methods: A systematic review and meta-analysis was Outcomes included rates of hospitalizations, physician performed using data from 16 published randomized visits, emergency department (ED) visits, moving into controlled trials (RCTs) and 18 cohort studies. The studies social housing, and justice charges. We followed were identified from MEDLINE/PubMed, PsycINFO, individuals from 5 years before to 20 years after diagnosis. EMBASE, SocINDEX, and Human resource management We constructed sex-stratified, generalized linear models databases from January 1995 to January 2016. Two with a log population offset to compare rates of health, authors independently screened selected studies and social services, and justice contacts between those with an assessed the quality of the studies. The main outcomes AUD and their matches. Models adjusted for time-varying were proportion of full and partial RTW, and sick leave mental health status and residence. duration until RTW. Results: We identified 52,991 individuals with an AUD: Results: The pooled results from 16 RCTs suggested that 64% male and 36% female. AUDs followed a the available interventions did not lead to improved RTW socioeconomic gradient. Across all social indicators, rates over the control group [pooled risk ratio 1.05 (95% individuals with an AUD had a significant spike in social confidence interval (CI): 0.97, 1.12], but reduced the

Book of Abstracts 48

number of sick leave by 13 days in the intervention group health services for depression and other psychological compared to the control group, with a mean difference of - problems were estimated. 13.38 days (95%CI: -24.07 to -2.69). Moreover, the meta- Results: The proportion of those who scored 13 or higher analysis of 18 cohort studies revealed that age, contact on K6 was highest among women aged 25-29 years old with medical specialists, RTW self-efficacy (SE), and work (7.3%), followed by women aged 30-34 years old (6.7%) ability were found to be significant prognostic factors for as of 2016. The proportion of those with K6 of score ≥13 RTW in workers with CMDs. seeking treatment was highest among women aged 40-44 Conclusions: Although the RTW interventions reduced years old, followed by women aged 35-39 years old as of the number of days of sick leave to RTW, there is no 2016. evidence supporting the effectiveness of the interventions Conclusion: There is a need for strategies to narrow on RTW rates in workers with CMDs. Interventions should treatment gap particularly focused on younger women. focus on improving RTW-related SE and enhancing work Funding: This study was supported by Health Labour ability to facilitate RTW in workers with CMDs. As mental Sciences Research Grant, Japan. health problems are affecting a large proportion of the working population, the results of this review may have PP46│Depression among long-term public health and economic implications. unemployed people screened for disability

pensions PP45│The age- and sex-specific trends in Kirsti Nurmela the prevalence of psychological distress University of Tampere, Tampere, Finland and the use of mental health services in Introduction: The interaction between unemployment and Japan ill-health is accounted for though both selection and Nishi Daisuke, Susukida Ryoko, Usuda Kentaro, causation mechanisms(1). Among mental health problems, depression has been shown to be especially closely linked Yamanouchi Yoshio (2) National Center of Neurology and Psychiatry, Tokyo, Japan with unemployment . Research on the clinical assessment of work ability of the long-term unemployed is (3) Introduction: The primary aim of this study was to scarce . The present study explores if a project examine the age- and sex-specific trends in the prevalence specifically targeted at work disabilities was able to detect of psychological distress and the use of mental health cases with permanent work disability among long-term services in Japan by using the Comprehensive Survey of unemployed people in particular with respect to Living Conditions in 2016. identification of depression. Methods: The data were drawn from the Comprehensive Methods: The data consists of the medical histories of Survey of Living Conditions (CSLC) in Japan. The CSLC is long-term (>1 year) unemployed people (n=364) who were a repeated national cross-sectional survey, which is referred to a screening project. The goal of the project was conducted annually by the Ministry of Health, Labor, and to identify those who might actually be unable to work. Welfare (MHLW) of Japan. This study used the CSLC data Those diagnosed at that point as clinically depressed were sets of 2016. The sample of the CSLC participants is classified into previously diagnosed and not previously so randomly selected from 5410 National Census districts of diagnosed. Binary logistic regression models were used to Japan, covering approximately 290,000 households. The explore the effect of previous depression diagnosis on outcome measures of this study were self-reported general being granted a disability pension. psychological distress and current use of mental health Results: Depression was diagnosed in 52% (N=188) of services for depressive symptoms. Psychological distress subjects and 64% of them were granted disability was measured by the Japanese version of the Kessler pensions. Among these 188 people, depression had been Psychological Distress Scale (K6). Following the previous previously diagnosed in 45%. The disability pension was studies, we defined a score of ≥13 on K6 as psychological significantly more likely to be granted to those without distress with serious mental disorder. Current use of earlier diagnosis of depression (odds ratio 2.2, p=0.012) mental health services for depression and other than to those whose depression had already been psychological problems measured whether study diagnosed in health care. The difference remained participants were seeing mental health providers for their statistically significant after adjusting for the set of depression and other psychological problems at the time background factors. of the CSLC survey. Age- and sex-specific percentages of Conclusion: Among the long-term unemployed, there are those with a score of ≥13 on K6 and those using mental many people with depression and such severely impaired working capacity that they are eligible for a disability

Book of Abstracts 49

pension. This, however, tends to go unnoticed in health questions of the ACE (adverse childhood experience) care. Furthermore, one reason for unidentified depression questionnaire. seems to be marginalization from healthcare services. Of The World Health Organization (WHO) Model Core the long-term unemployed who suffered from depression Questionnaire was used to collect data on psychoactive and who were granted a disability pension through the substance use. Chi square test was used to test the screening project nearly a quarter had visited health care association between family dysfunctions and psychoactive at maximum of three times in the preceding three years substance use, while binary logistic regression was used and nearly a tenth had not visited health care at all in the to ascertain the strength of the association. three years prior to the project. Clinical screening of the Results: Three hundred and forty-two (86.1%) of the 397 long-term unemployed in terms of work disability seems to prison inmates newly brought to custody over a 4-month be worthwhile. period (August 2017 - January 2018) participated in the Acknowledgements: This work was supported by the study. Significant relationship was found between Finnish National Graduate School of Clinical Investigation psychoactive substance use and parental (CLIGS). separation/divorce, parental drug use, household member References: with mental illness, and imprisonment of a household Kaspersen SL, Pape K, Vie GÅ, Ose SO, Krokstad S, member. No significant relationship was found between Gunnell D, et al. Health and unemployment: 14 years of domestic violence and drug use. follow-up on job loss in the Norwegian HUNT Study. Eur J One hundred and seventy-six (51.5%) of the participants Public Health. 2016;26(2):312-317. reported using drug 30 days prior to arrest, while the Comino EJ, Harris E, Silove D, Manicavasagar V, Harris remaining 166 (48.5%) did not. Pattern of drug use MF. Prevalence, detection and management of anxiety identified cannabis as the commonest drug used 74 and depressive symptoms in unemployed patients (21.6%); this was followed by tobacco (cigarette) at 27 attending general practitioners. Aust N Z J Psychiatry. (7.9%), and alcohol at 26 (7.6%). Volatile inhalant was the 2000;34(1):107-13. least used drug 2 (0.6%). Lifetime and 12 months Kerätär R, Taanila A, Jokelainen J, Soukainen J, Ala- prevalence of psychoactive substance use were 66.4%, Mursula L. Work disabilities and unmet needs for health and 56.1%, respectively. care and rehabilitation among jobseekers: a community- Conclusion: offenders who experienced household level investigation using multidimensional work ability dysfunction in the family are more likely to use assessments. Scand J Prim Health Care. 2016;34(4):343- psychoactive substance. Interesting but worrisome is the 51. use of volatile inhalant and opioid, which hitherto were not popular in Nigeria. Program aimed at prevention and PP47│Family dysfunctions: Implications for treatment of drug use and problems associated with drug psychoactive substance use among use should be designed in such a way that family members are included. offenders in a Nigerian prison Keywords: crime, drug, prison, family. Johnson Okoro1, Jude Owoh2, Chinenye Ezeonwuka3, Anthony Iloh4, Eunice Ejiofor4, Stanley PP48│Gabapentin abuse: Prevalence and 4 Udeagha all-cause or drug-related medical events 1 Nigerian Prisons Service, Health and social welfare department, Enugu, Nigeria; 2Quinnipiac University, with and without concomitant opioid abuse Connecticut, USA; 3Project Development Institute, Enugu, Alyssa M. Peckham, Kathleen A. Fairman, David A. Nigeria; 4Federal Neuropsychiatric Hospital, Enugu, Nigeria Sclar Midwestern University, College of Pharmacy-Glendale, Introduction: The study was set out to examine the impact Glendale, USA of family dysfunctions on psychoactive substance use among offenders newly brought to custody in a Nigerian Background: Despite international calls to make prison. gabapentin a controlled substance, studies of gabapentin Methodology: The study was a cross-sectional design; use/abuse patterns are limited to small/high-risk samples and, a convenient sampling technique was used to select and adverse event reports. As such, gabapentin may be 342 new inmates entering prison custody in a Maximum abused to potentiate opioid effects, though studies of Security Prison Enugu, Nigeria. Data on family dysfunction medical events resulting from co-abused were obtained using the 5 household dysfunctions gabapentin/opioids are lacking. The primary objectives were to conduct a systematic assessment of the abuse

Book of Abstracts 50

potential/prevalence of gabapentin in a large sample, and opioids may increase risk of harm and health-service assess patient harm, defined as use of inpatient hospital utilization, supporting calls to make gabapentin a (IPH) or emergency department (ED) services, associated controlled substance in the USA. This study was not with overuse of gabapentin with or without concomitant funded. overuse of opioids. Methods: Data were from the Truven Health PP49│Mental demands at work as MarketScan(r) Commercial Claims and Encounters protection against dementia? Results from database, for the years 2013-2015. For prevalence assessment, patients with >2 claims for >1 abusable drugs longitudinal Cohort studies and >12 months' continuous enrollment were sampled for Francisca S. Rodriguez (Then) Lorenz curve analysis. Prevalence analysis was limited to University of Southern California, Los Angeles, USA those with >120 days of therapy. Abuse potential was measured as Lorenz-1 (consumption of drug supply by top Background: Previous studies have shown that people 1% of users) of >15%. Dose thresholds were morphine who work in intellectually stimulating jobs have a lower risk milligram equivalent (MME) standards for opioids, and for developing dementia. Aim of the study was to maximum labeled doses in milligrams (mg) for other drugs. determine what aspects of those jobs are the driving For medical events assessment, patients with >2 claims factors that actually reduce dementia risk. (billed encounters) and >120 days of treatment with Methods: Using longitudinal population-based studies gabapentin and/or opioids were included. Cohort (LEILA75+, AgeCoDe), a concept-based and a data-driven identification was based on daily-dosage thresholds of 50 approach was used to analyse the relevance of mental MME and 3,600 mg of gabapentin in a 12-month follow-up: demands at work on dementia risk. (1) no overuse; (2) mild overuse (>2 claims or <2 calendar Results: Multivariate logistic and cox regression models quarters over threshold); and (3) sustained overuse (>3 suggest that activities at work that come with high over-threshold calendar quarters). IPH and ED use were demands on information processing (e.g., use of measured for 6 months after the first overuse date (cohorts knowledge, developing strategies, solving problems) are 2 and 3) or a randomly assigned date (cohort 1). Logistic consistently associated with a reduced dementia risk, in regression analyses controlled for pretreatment IPH/ED the concept-based as well as the data-driven approach. utilization, indication, addiction diagnosis, concomitant Conclusions: The lower dementia risk observed in sedative/hypnotic use, and demographics. connection with having worked in intellectually stimulating Results: Lorenz-1 values were 37% opioids, 19% jobs could be explained by a more proficient use of gabapentin, 15% pregabalin, 14% alprazolam, and 13% information processing skills throughout working life. zolpidem. The top 1% gabapentin users filled prescriptions Further studies may evaluate how information processing for a mean (median) 11,274 (9,534) mg/day, >3 times the skills make cognitive functioning more resistant to recommended maximum (3,600 mg). Of these, one- neuropathological damage in old age. quarter used or diverted >12,822 mg/day. The top 1% opioid and pregabalin users filled prescriptions for a mean PP50│The role of education and income on (median) 180 (127) MMEs and 2,474 (2,219) mg/day, cognitive functioning in old age: A cross- respectively. Of patients using opioids + gabapentin country comparison simultaneously, 24% had >3 claims exceeding the dose threshold within 12 months. All-cause and drug-related Francisca S. Rodriguez (Then) IPH/ED utilization increased monotonically with degree of University of Southern California, Los Angeles, USA overuse, particularly of more than one medication. Introduction: People with low socioeconomic status have Sustained overuse of gabapentin multiplied odds of all- a higher risk for age-related cognitive impairments and cause IPH by 1.366 [95% confidence interval (CI) 1.055- dementia. It is not known to what extent education and to 1.769], drug-related IPH by 1.440 (95% CI 1.010-2.053), what extent income is driving the observed effects. Aim of and IPH/ED for altered mental status (e.g., euphoria, the study was to disentangle the role of education and anxiety) by 1.864 (95% CI 1.324-2.624). Sustained income on cognitive functioning in old age by conducting overuse of both medications quadrupled odds of all-cause cross-country analyses. IPH, drug-related IPH, and IPH/ED for altered mental Methods: Using data from the Health and Retirement status or respiratory depression. study (HRS, USA), the Survey of Health, Ageing and Conclusion: Gabapentin use patterns are similar to those Retirement in Europe (SHARE, European countries), and of other abusable medications. Despite modest effects of the WHO's study on global Ageing and adult health (SAGE, gabapentin overuse alone, overuse of gabapentin with

Book of Abstracts 51

China, Ghana, India, Mexico, Russia, South Africa), we to T2 was created. Logistic regression analyses, stratified analysed the role of income and education on performance by gender, were used to analyze the data. in the word list learning test in individuals aged 55 years Results: Men experiencing stable high alcohol use or and older. developing high alcohol use between T1 and T2 had Results: Education largely predicts cognitive performance significantly higher odds of experiencing symptoms of in old age. Income has only a marginal effect whereby the insomnia at T2, compared to men with a stable low alcohol absolute value of income seems to be more relevant than use at T1 and T2. Likewise, men experiencing stable relative income. Cross-country analyses emphasize that symptoms of insomnia or developing symptoms of the effect of education and income is larger in the United insomnia between T1 and T2, had significantly higher odds States compared to Sweden and Germany. Further, higher of experiencing high alcohol use at T2, compared to men education or income was associated with much smaller with no insomnia symptoms at T1 or T2. No significant gains in Ghana than in other countries. effects were detected among women. Discussion: The findings suggest that, even when taking Conclusion: The results of our study indicate that there is income in consideration, education has a strong effect on a bidirectional relationship among alcohol use and cognitive functioning in old age. Increasing access to symptoms of insomnia among men. Among women, no higher education should therefore be a major objective of longitudinal relationship was detected, which may suggest public policy in aging societies. Yet, there are considerable that the relationship between alcohol use and insomnia differences in effect size between countries that should be may depend upon gender. addressed in further studies. The project is funded by the Northern Norway Regional Health Authority (Helse Nord). PP51│The bidirectional relationship between alcohol use and insomnia PP52│Knowledge, attitudes and behavior symptoms: Results from the Tromsø Study towards mental illness among adult college Kamilla Rognmo, Katja Bratlid, Jan Rosenvinge, students Svein Bergvik, Oddgeir Friborg Rowalt Alibudbud UiT The Arctic University of Tromsø, Tromsø, Norway University of the Philippines - Philippine General Hospital, Manila, Philippines Introduction: Alcohol use disorders and insomnia are common afflictions. Every year approximately 10% of the Introduction: Stigma is a barrier for students who seek adult Norwegian population meet the requirements for help. It leads to under-treatment, poverty, and alcohol abuse/dependence, whereas about 11% meet the marginalization. It is expressed differently in different requirements for insomnia. Insomnia is particularly cultures. Stigma encompasses problems of knowledge, prevalent among people struggling with alcohol use attitudes and behavior. Knowledge refers to literacy disorders. The relationship between alcohol use and sleep regarding mental health disorders and treatment. Attitudes problems has been extensively, and the results of the refers to benevolence, community mental health ideology, studies leave no doubt; alcohol use and sleep problems authoritarianism and social restrictiveness, Behavior refers are related. However, there is great variability in the results to discrimination. The objective of this study is to describe of the existing research, and the methodology and models and correlate the knowledge, attitudes and behaviors tested also varies to a great extent. Additionally, practically towards mental illness among adult college students using all of the studies have investigated alcohol use/misuse or the Mental Health Knowledge Schedule (MAKS), insomnia as a predictor of the other, rather than Community Attitude towards the Mental Illness III (CAMI- investigating the bidirectionality of the relationship. This III) scale and Reported and Intended Behavior Scale warrants further examination of the longitudinal (RIBS). relationship between alcohol use and insomnia symptoms. Methodology: The study was approved by the university's Method: The present study is based on data from two research ethics board. Questionnaires were content and waves (T1: 1994-1995, and T2: 2007-2008) of the Tromso face validated by experts from the hospital's department of Study, a population-based health study of the adult Psychiatry. Questionnaires were administered to 260 population of Tromso, Norway. In total, 10,325 (79.5% of college students through stratified random sampling. Data the T2 participants) participated at T1 and T2. Alcohol use were analyzed using mean, frequencies, item analysis and and symptoms of insomnia were measured using self- correlation coefficient. report questionnaires. A variable incorporating change and Results: Students have high mental literacy but were stability in alcohol use and symptoms of insomnia from T1 confused about the concepts of stress and grief. They were

Book of Abstracts 52

tolerant, respectful and inclusive of the mentally ill's roles and frequency of alcohol and other drug use, CIDI-based and rights in society but half of them still viewed mental mental health and substance use disorders, chronic health hospital as indispensable and were guarded in the conditions, suicidal ideation, severity of disability and other mentally ill's role in caring for young children, while a indicators. Logistic regression predicted severity tier quarter had misconceptions about mental illness membership based on a small number of predictors: age, recognition and etiology. Knowledge positively correlated sex, immigrant status, and a meso-level measure of social with benevolence (r=0.3; P-value=<0.0001) and negatively deprivation. Severity tier membership probabilities were correlated with social restrictiveness (r= -0.35; P- calculated for Canadian health planning regions and value=<0.0001). Knowledge had insignificant correlation applied to the regions' age-sex distribution of 2016. with behavior. Nondiscriminatory behavior positively Results: The following prevalences were obtained: Tier 1 correlated with benevolence (r=0.34; P-value=<0.0001) = 43.3%, Tier 2 = 26.5%, Tier 3 = 17.7%, Tier 4 = 11.2%, and community mental health ideology (r=0.45; P- and Tier 5-the most severe and complex-1.3%. Including value=<0.0001). Nondiscriminatory behavior negatively immigrant status in regressions increased variance correlated with authoritarianism (r= -0.34; P- explained by six percent. value=<0.0001) and social restrictiveness (r= -0.39; P- Conclusion: Our algorithm and model can be used to value=<0.0001). allocate populations to different severity tiers based on a Conclusion: Students have high knowledge, small number of predictors usually available in community benevolence, community mental health ideology and surveys. Pilot work is underway in several Canadian intended nondiscriminatory behavior. While, they have low provinces and sub-regions, comparing projected need to authoritarianism and social restrictiveness. Behavioral and current system capacity. Stakeholders value the attitudinal interventions are preferable to educational availability of regional-level data expressed quantitatively interventions in reducing discrimination. Results contradict as a health pyramid and corresponding to levels of the 1981 WHO study which included the Philippines. required intervention (e.g. acute psychiatric care or Compared with previous generations, the challenge in medical detoxification; community treatment, screening reducing discrimination is to improve attitudes. Hence, and brief intervention). Limitations identified include the stigma may not only vary by culture, but may also vary by need for a similar approach to child and adolescent generation. populations; challenges with survey exclusions such as Indigenous people living on reserve and people who are PP53│Estimating the need for mental health homeless; and challenges with current treatment and addictions treatment as a population information systems required for measuring treatment capacity (e.g., lack of integrated systems across mental health pyramid health and addictions). Funding support from Health Brian Rush1, Chris Kenaszchuk1, Scott Patten2, Joel Canada Anti-Drug Strategy Initiatives (ADSI). Tremblay3, Daniel Vigo4 1Centre for Addiction and Mental Health, Toronto, Ontario, PP54│Comprehensive assessment of Canada; 2University of Calgary, Calgary, Alberta, Canada; 3Universite du Quebec a Trois-Rivieres, Quebec, Canada; cardiorespiratory and physical fitness in 4Simon Fraser University, Burnaby, British Columbia, Canada patients with depression and schizophrenia Filip Rybakowski1, Katarzyna Drews1, Anna Introduction: International research has drawn attention Jasinska-Mikolajczyk1, Katarzyna Domaszewska2 to the size and importance of the treatment gap for mental 1Department of Adult Psychiatry, Poznan University of Medical health and addictions treatment systems. However, Sciences, Poznan, Poland; 2Department of Physiology, defining and measuring the need for treatment in University School of Physical Education, Poznan, Poland accordance with increasingly accepted stepped-care or "tiered models" of treatment systems, is challenging. Going Introduction: Mental disorders are the leading cause of ill beyond diagnostic approaches, we developed a model of health and disability worldwide. The life expectancy of treatment need based on population-level data on levels of patients with depression and schizophrenia is severity and complexity. approximately 10 - 15 years shorter than in the general Methods: We used the 2012 Canadian Community Health population, which is caused by co-existing somatic Survey - Mental Health to define five severity tiers of need diseases such as cardiovascular and metabolic illnesses. for the Canadian population aged 15 and over. Tier About 75% of psychiatric patients lead an inactive lifestyle membership was based on an algorithm that purposefully and do not meet the World Health Organization (WHO) allocated cases based on survey responses about quantity criteria for physical activity. Recently, American Heart

Book of Abstracts 53

Association recommended measuring cardiorespiratory making skill on the effect of the #Tamojunto program on fitness (VO2max) as a clinical vital sign, based on the drug use and the practice of violent behavior in schools evidence that lower fitness levels are associated with high after 21 months. risk of cardiovascular disease, cancer, and all-cause Methods: A two-arm three-wave cluster randomized mortality. controlled trial, with schools as the unit for randomization, Methods: The study aimed to compare physical fitness was conducted in 72 public schools in 6 Brazilian cities. (cardiorespiratory fitness, strength, and flexibility, agility Surveys to assess the effectiveness of the program were and balance) of hospitalized patients with depression (D, conducted among 6,391 students in 7th and 8th grades prior n=37), schizophrenia (S, n=16) and control group (C, to intervention implementation, then 9 and 21 months after n=39). Maximal oxygen uptake (VO2max) was estimated baseline. The intervention group attended 12 weekly using the Astrand-Rhyming gender-sensitive nomogram. classes of the #Tamojunto drug prevention program, and The physical efficiency was assessed using a 6-task the control group did not attend any prevention program Fullerton test. One-way ANOVA with post-hoc HSD Tukey during the study. Analysis were conducted under the test was used to determine the differences between counterfactual mediation approach to evaluate the indirect groups. effects of the program #Tamojunto on prevalence of drug Results: Patients with schizophrenia, depression and use and violence via decision-making skills. The outcomes controls were matched with regard to age: 34.1±8.5, investigated at the third wave were 1) any past year drug 37.6±12.7 and 32.8±11.4 years respectively (p=0.19), but use (alcohol, tobacco, marijuana, inhalants, and binge not BMI 28.0±6.8, 26.4±5.5, 23.9±3.2 kg/m2, (p=0.01). drinking) and 2) episodes of any bullying, physical, verbal Both clinical groups showed lower circulatory and and sexual aggression. Covariates were gender, age, respiratory capacity than the control group- VO2max, S: socioeconomic status and baseline measures of drug use, 27.9±5.9, D: 29.3±7.7 and C: 38.1±10.5 mL/(kg·min); violence and decision-making skills. Missing data were p<0.001. They also achieve lower results in all subtests of imputed using Bayes estimation of an unrestricted Fullerton fitness test; Chair stand: 15.3±4.9, 16.8±6.0 and variance-covariance model. Direct and indirect effects 22.0±6.0 (p<0.001) S,D (p=0.003) S,D±120.7, were calculated in Mplus 8.0, with a confidence interval of 565.2±119.7 and 611.9±137.6 (p<0.001) S,DC. 95%, being the standard error adjusted for the cluster Conclusion: Patients with schizophrenia and depression design. show reduced levels of cardiorespiratory and physical Results: The students were 12.5 (SD 0.7) years-old at the fitness. Insufficient physical activity and sedentary lifestyle baseline and 51.2% were girls. The proportion of mediated probably contribute to the increasing mortality gap effect of on drug use via decision-making skills was between psychiatric patients and the general population. 59.25%. The total natural indirect effect (TNIE) was Our results may suggest that physical training should significant for quantity of drugs used (TNIE= 0.016, become an integral element of treatment for schizophrenia, 95%CI= 0.005-0.027) and violent behaviors (TNIE= - depression and other severe mental disorders. 0.005, 95%CI= -0.010; -0.001). The total natural direct effect was not significant for both outcomes. PP55│Decision-making skills as mediator of Conclusions: #Tamojunto program increases the drug the #Tamojunto school-based prevention use and reduces the practice of violent behavior due to the increasing in the decision-making skills. program for drug use and violence: A Funding: Brazilian Ministry of Health, TED 89-2014 counterfactual mediation model Zila Sanchez1, Juliana Valente1, Hugo Cogo- PP56│Mortality by violent causes among Moreira2 adolescents 10 to 24 years old in Argentina 1Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil; 2Department of Psychiatry, 2001 to 2010 Universidade Federal de São Paulo, São Paulo, Brazil Edith Serfaty Instituto Investigaciones Epidemiologicas, Buenos Aires, Introduction: The European school drug prevention Argentina program Unplugged, in Brazil named #Tamojunto, is based on the Comprehensive Social Influence approach, Death by violent causes in adolescents constitutes nearly expected to improve adolescents' personal and half of the total deaths for this age, representing a interpersonal skills through interactive techniques and challenge to Public Health, although they are totally normative education. The aim of the present study was to preventable. evaluate the mediator effect of adolescents' decision-

Book of Abstracts 54

Objective: To study the causes of mortality rates in were associated with a higher educational level and subjects of 10 to 24 years old in Argentina between 2001 increased psychiatric morbidity. In the multivariate to 2010. analysis, statistically significant associations for the Material and methods: Using the data of the Ministry of presence of stigmatized beliefs remained for non-urban Health for deaths, we studied the causes of death in the type of location and presence of chronic medical diseases, age groups 10 to 14, 15 to 19 and 20 to 24 years old, for while for more positive beliefs for economically inactive both sexes, determining the deaths, percentages and persons and increased psychiatric morbidity. rates. We followed the International Clasification of Conclusion: A large proportion of the general population Diseases. have negative beliefs about psychiatric medications. This Results: Between 2001 and 2010 the quantities of death is reduced in participants who experience a common remained constant at between 8.600 and 8.900 per year. mental disorder. Psychoeducational programs could be Traffic accidents represented the most frequent cause, designed with the aim to reduce negative stereotypes follow by other accidents, suicides and homicides. All about psychiatric medications. these causes are more frequent amongst males. Discussion: The rates found are similar to those of other PP58│Depression and panic disorder Latinamerican countries and of the World Health among a community sample in Haiti Organization. This highlights the importance of 1,2, 1,2 implementing plans of prevention and diagnoses, as soon Catherine W Striley , K. Vaddiparti , V. 1 1,2 as possible in order that the causes are preventable. To DeGennaro , L.B. Cottler investigate psychopathology problems such as alcohol University of Florida College of Medicine and College of Public and drug consumption in adolescents could be a way to Health and Health Professions, USA avoid these mortality causes, like suicide. In one study among rural Haitian adults, 42% had Key words: adolescence, mortality, violence moderate and 23% were assessed to have severe

symptoms of depression. Lifetime history of panic attacks PP57│Lay beliefs about psychiatric has not been measured in Haiti among community medications in a nationally representative samples. sample of the general population of Greece A study of the prevalence of non-communicable diseases Petros Skapinakis, Andreas Karampas, Petros (hypertension, diabetes, chronic renal insufficiency, major Petrikis, Venetsanos Mavreas depressive disorder (MDD), panic disorder (PD) and Department of Psychiatry - University of Ioannina School of substance use disorders) among a sample of 2,133 door- Medicine, Ioannina, Greece to-door recruited Haitians 25 to 65 years of age was conducted by the Haiti Health Study. The study was Background: Lay beliefs about psychiatric drugs are approved by the University of Florida IRB and the Haitian important because they may increase the stigma attached Ethics Board. Among this community sample, here we to mental disorders and reduce compliance to treatment. report lifetime rates of MDD and PD. The aim of the present research is to describe the beliefs Trained Haitian Community Health Workers (CHWs) of the general public in Greece about psychiatric enumerated homes and assessed one randomly selected medications and to investigate their associations with family member for health and mental health, social sociodemographic associations and psychiatric morbidity. determinants of health, height and weight, and blood Methods: We used a nationally representative sample of pressure, and tested blood glucose, creatinine and lipids. 4984 participants aged 18-74 years old and living in private The Diagnostic Interview Schedule for DSM-IV, a households. We assessed psychiatric disorders using the structured diagnostic interview, was used to capture MDD revised Clinical Interview Schedule (CIS-R). We used the and PD symptoms and disorder diagnosis among rural "Beliefs about medicines Questionnaire (BMQ)" to assess (n=706) and urban (n=1427) participants. SAS 9.4 was lay beliefs about psychiatric medications. used for data analysis. Results: 19.8% of the participants had extremely negative Among the 2133 adults, 39% were male, mean age was beliefs about psychiatric medications ("stigmatized" 40.8 (SD 11.8) years of age and 26.1% said they had good beliefs) and 9.3% had positive beliefs (less stigmatized). In to excellent health. Lifetime depression prevalence using the univariate analysis, a higher prevalence of stigmatized a diagnostic algorithm was calculated to be 45.9%; lifetime beliefs was reported by the unemployed, participants living panic disorder prevalence was calculated to be 46.7%, in rural - semi-rural locations, and those with chronic while 32.7% met criteria for both. medical conditions. More positive beliefs (less stigmatized)

Book of Abstracts 55

Depression and panic disorder prevalence calculated Conclusion: Although psychotic experiences are common using a structured diagnostic interview show that these in Thailand, apparently only a few of the people reporting problems are common among community dwelling them seek help. Knowing that psychotic experience could Haitians, with almost 1 out of 2 assessed positive for one be a window of opportunity to the prevention of the more or the other, and 1 out of 3 assessed positive for both over serious mental illnesses, a better understanding of this the lifetime. Given the importance of both to physical health behaviour is essential. Better psycho-education or mental and functioning, low-cost and low-resource interventions to health promotion could aid in the early detection and treat these problems are needed. intervention for this group of people.

PP59│Help-seeking behaviours of people PP60│Depression, anxiety, and pain: with psychotic experiences: Results from Understanding subgroups of newly the 2013 Thai National Mental Health Survey admitted nursing home residents Suttha Supanya1, Craig Morgan1, Ulrich Christine Ulbricht1, Jacob Hunnicutt1, Giovanni Reininghaus2, Thai Mental Health Survey Work The, Gambassi2, Anne Hume3, Kate Lapane1 Department of Mental Health, Ministry of Public 1University of Massachusetts Medical School, Worcester, USA; Health, Bangkok, Thailand 2Catholic University of Sacred Heart, Rome, Italy; 3University of 1Institute of Psychiatry, Psychology and Neuroscience, King's Rhode Island College of Pharmacy, Kingston, USA College London, London, United Kingdom; 2Department of Psychiatry and Neuropsychology, School for Mental Health and Background: Pain, as experienced by nursing home Neuroscience, Maastricht, Maastricht, Netherlands residents, is a global health problem. Pain also commonly co-occurs with psychiatric disorders such as depression Introduction: Psychotic experiences have emerged as an and anxiety. Despite the burden of these often multimorbid enticing medium for understanding the development and conditions, knowledge about the multidimensional severity of many psychopathologies including psychosis, presentation of pain among nursing home residents is common mental disorders and suicidality. Recent research lacking. The goals of this study were to: 1) identify suggests these experiences are common in general subgroups of pain and related symptoms among newly population; however, there is still a lack of information on admitted nursing home residents in the U.S.; 2) examine those who report them, especially their help-seeking correlates of belonging to these subgroups. behaviours. Using the data from the 2013 Thai National Methods: National data on adults 50 years and older Mental Health Survey, we sought to study help-seeking residing in U.S. nursing homes from 2011-2012 was patterns among those who report psychotic experiences in obtained from the Minimum Data Set (MDS) 3.0. The MDS the Thai population. 3.0 assessment contains items on active clinical Methods: The 2013 Thai National Mental Health Survey diagnoses, treatments, physical functioning, and cognitive fully utilised the approach of the World Mental Health impairment. We identified 119,379 residents reporting Survey to collect data from eligible participants aged 18 nonmalignant pain at admission. A latent class analysis and above in the community. The Thai version of WHO- was conducted using 12 pain and mood indicators. CIDI 3.0 was used and contains the psychosis screen (PS) Associations between covariates and latent subgroup section that assesses the prevalence, number, and types membership were examined with multinomial logistic of psychotic experiences. It also asks whether the models (adjusted odds ratios (aOR); 95% confidence respondents had sought help for any of the experiences. intervals (CI)). Results: Of the 4727 participants who completed the Results: Four latent subgroups were identified: Severe interview, 269 (5.9%) reported any psychotic experience in Pain (15.2% of residents), Moderate Frequent Pain their lifetime. Of these, 88 (32.7%) were men and 181 (26.4%), Moderate Occasional Pain with (26.4%) and (67.3%) were women, the majority (59.5%) were married, without (32.0%) Depressive Symptoms. Depressed mood, most (61.0%) only attained primary-level education or less, sleep disturbances, and fatigue distinguished subgroups. and most were employed or self-employed (70.1%). Age ≥75 years and severe cognitive impairment were However, just 36 (12.7%) had ever sought help from any inversely associated with membership in the Severe and health professional. Of this group of participants, only 6 Moderate Frequent subgroups while racial/ethnic minority (36.5%) were hospitalised from a psychotic diagnosis. No status was inversely associated with membership all the socio-economic variables were associated with help- subgroups. Having an active depression diagnosis was seeking behaviours. associated with increased odds of belonging to the Severe (aOR: 1.68; 95% CI: 1.60-1.76) and Moderate Occasional

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with Depressive Symptoms (aOR: 1.55; 95% CI: 1.48- (mental) health care services to be available especially at 1.62) subgroups. Residents with an active anxiety disorder high risk moments; at spring time and in the beginning of had increased odds of membership in the Severe (aOR: January. Further research is needed to explore the 1.75; 95% CI: 1.66-1.85), Moderate Occasional with protective effect of Christmas in suicide incidence. Depressive Symptoms (aOR: 1.40; 95% CI: 1.33-1.48), and Moderate Frequent (aOR: 1.16; 95% CI: 1.09-1.23). PP62│The mental-health crisis among Conclusion: We identified four subgroups of pain migrants and refugees: The value of an symptoms among newly admitted nursing homes, indicating that pain is a multifaceted physical and integrated existential treatment approach psychological syndrome. A more comprehensive Henry Venter1, Catharina Venter2 understanding of non-malignant pain may lead to more 1National University, Los Angeles, USA; 2National University, effective management of pain and pain-related symptoms San Diego, USA than if each symptom in isolation were treated. Introduction: There is a modern day diaspora of migrants and refugees as these desperate people flee into PP61│Seasonality of suicide incidence and developed countries. Initial studies in Germany determined the protective effect of Christmas. A national that these refugees and migrants are suffering very high longitudinal population-based study in the levels of psychiatric disorders due to their experiences — Netherlands violence, loss, uprooted lives — leaving them particularly Christina Van der Feltz-Cornelis, Emma Hofstra, vulnerable to developing depression, anxiety and PTSD. Iman Elfeddali, Marjan Bakker, Jacobus De Jong, Researchers and therapists are struggling to help. Preliminary findings indicate that the stress and trauma of Chijs Van Nieuwenhuizen upheaval is creating far more strain than previously Tilburg University, Tilburg, Netherlands recognized. Three windows of extreme stress for refugees

are recognized: the often violent traumas in their home Background: Time trends in suicide incidence have countries that led to their flight; the journey itself; and the gained growing scientific attention. Insight into time trends arrival, when people are thrust into a foreign country. can contribute to the development of effective suicide According to psychiatrist Malek Bajbouj, who has prevention strategies. performed groundbreaking work with this population in Methods: Time trends in national daily and monthly data Germany, “The latter ‘post-migration’ phase is becoming of 33,224 suicide events that occurred in the Netherlands increasingly important. Suddenly they realize they have from 1995 to 2015 were examined, as well as the influence lost everything, have no control over aspects of their lives of age, gender and province, in a longitudinal population- and no social standing. Refugees may arrive in Germany based design with Poison Regression Analysis and with great hope, but then find themselves stuck for months Bayesian Change Point Analysis. in camps with no apparent prospects.” Results: Suicide incidence among Dutch residents Methods: The newly developed treatment model, increased from 2007 until 2015 by 38%. Suicide rates peak developed by this researcher and his colleague, the in spring, up to 8% higher than in summer (p<.001). Integrated Person-Centered and Existential (IPCE) model, Suicide incidence was 42% lower at Christmas, compared aimed at addressing the underlying existential issues of to the December-average (IRR=0.580, p<.001). After trauma such as violence, displacement, loss of meaning Christmas, a substantive increase occurred on January 1, and purpose, will be utilized in the treatment of a cross- which remained high during the first weeks of the New section of the refugee population in the Los Angeles area. Year. Suicide occurred more than twice as often in men Existential therapy, with its emphasis on helping people than in women. For both genders the results indicated a find meaning in their changing world, naturally lends itself spring time peak in suicide incidence and a trough at to address the unique issues of refugees and migrants Christmas. Suicide rates were highest in the elderly (age including trauma and the loss of purpose and meaning. group 80+) and an effect by season was found among Results: Initial results utilizing this newly developed model people aged 40 to 79 years. The Christmas effect was treating people with trauma specifically with loss of found in the provinces Utrecht (IRR=0.264, p=.022), meaning and purpose has been promising. The results of Noord-Brabant (IRR=0.383, p=.002), Noord-Holland previous implementation cannot at this stage be (IRR=0.551, p=.023) and Zuid-Holland (IRR=0.589, generalized to other populations. However, initial p=.028). implementation indicated that the newly developed Conclusion: Evidence was found for time trends in suicide treatment model has promise for the future treatment of the incidence in the Netherlands. It is recommended to plan

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refugee and migrant population in the post-migration Results: At baseline, half of symptomatic adolescents phase, where they realize they have lost everything and perceived having a MH problem, with more adolescents in suffers from loss of purpose and meaning. the curriculum only group self-perceiving a problem than Conclusion: Society is facing a unique new crisis dealing control. Although adolescents had declining self- with mental health issues among the migrant and refugee perceptions over time, those who received the curriculum population, many coming from areas where psychological had a sustained advantage in the long-term versus control, treatment did not exist. This new model, which effectively adjusting for baseline self-perceptions, type of symptoms, translates the tenets of Existential Theory and Person- and other factors. Among symptomatic adolescents who Centered therapy into a counseling process that is more did not perceive a problem at baseline, the curriculum readily accessible to practitioners in a five-phase model significantly improved self-perceptions relative to control. and also provides measurable and replicable data suitable Adolescents in the contact only and curriculum/contact for qualitative research, is easily understandable and can groups versus control improved their perceptions that the prove to become an evidence-based treatment modality for character with social anxiety disorder had a MH problem. the growing refugee population suffering trauma-related These perceptions increased among those in the contact mental illness and other symptoms following their plight. only and curriculum/contact interventions until the 12- and The newly developed IPCE treatment model can also be 18-month follow-up assessments, respectively. No easily replicated by other researchers. intervention effects were observed for the character experiencing bipolar disorder. PP63│Does a school-based anti-stigma Conclusion: Although the interventions did not specifically intervention help improve perceptions of address strategies for evaluating MH, the curriculum improved self-perceptions of MH problems among mental health problems in symptomatic symptomatic adolescents who did not perceive a problem adolescents? at baseline. Likewise, the contact intervention improved Alice Villatoro1, Melissa DuPont-Reyes1, Jo Phelan2, perceptions that the character with social anxiety had a Bruce Link3 problem. These interventions may be useful for enhancing 1The University of Texas at Austin, Austin, Texas, USA; perceptions of mental illness among adolescents in need 2Columbia University Mailman School of Public Health, New of treatment. York, New York, USA; 3University of California, Riverside, Riverside, California, USA PP64│Bayesian prediction intervals for

Introduction: Perceptions of having a mental (MH) assessing P-value variability in prospective problem are vital to the initiation of help-seeking among replication studies adolescents. Although dependent on adults for entry into Olga Vsevolozhskaya1, Jim Anthony2, Dmitri Zaykin3 formal services, the perception of having a MH problem 1University of Kentucky, Lexington, USA; 2Michigan State may be important for adolescents to seek and pursue University, East Lansing, USA; 3 NIEHS, Research Triang, USA mental health support and services. However, not all youth perceive their symptoms as problematic. This study Introduction: Independent replication of published effects assessed the longitudinal impact of a school-based anti- is at the heart of any scientific research. Low replicability stigma intervention on perceived MH in symptomatic of positive results in psychology has lead to a crisis of adolescents. confidence in psychological science. In the wake of the Methods: A diverse sample of symptomatic sixth-graders current replicability controversy, there is a realization that (n=303) were analyzed using two-year longitudinal data a reported "statistically significant" claim may be spurious. from a randomized school-based anti-stigma intervention The aim of this work is to provide a simple method to study. The following intervention groups were compared to calculate future P-value variability, thus avoiding a control group: (a) an anti-stigma curriculum, (b) contact overinterpretation of very significant, but highly variable with a young adult who described their experiences with statistics. mental illness, and (c) combined curriculum/contact Methods: We describe theoretical derivation and provide interventions. Adolescents reported their self-perceived a link to software of our Mixture Bayes approach, that MH status during six assessment periods. Adolescents allows one to construct a Bayesian prediction interval to also reported on their MH perceptions of vignette assess variability of a future replication P-value based on characters described as adolescents experiencing bipolar a P-value from the initial study. A major advantage of and social anxiety disorders, respectively. Bayesian intervals is that their endpoints have interpretation as probabilistic bounds for a P-value they

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were constructed for. In contrast, classical confidence admitted, in relation to: (a) suicide methods; (b) types of interval bounds lack that interpretation. accidental death; (c) types of fatal poisoning. Results: We considered recent finding from Psychiatric Results: Suicide risk was 32 times higher among Genomic Consortium (PGS) that reported association discharged patients compared to individuals without between a single nucleotide polymorphism (SNP), psychiatric admission history (IRR 32.3; 95% CI 29.2-35.8) rs2535629, and attention deficit-hyperactivity disorder and was even higher during the first-year post-discharge (ADHD), autism spectrum disorder (ASD), bipolar disorder (IRR 70.4; 95% CI 59.7-83.0). Among persons who died by (BPD), major depression disorder (MDD), and suicide, risks of jumping from height and of intentional self- schizophrenia. Based on the originally published P-values, poisoning by prescribed or illicit drugs were particularly we constructed 95% prediction intervals for replication P- elevated. Relative risk for intentional self-poisoning (IRR values using prior effect size distribution reported by Chen 40.8, 95% CI 33.9-49.1) was significantly greater than for et al. (2013). Our results suggest that a replication of all 'violent' suicide methods (IRR 29.4, 95% CI 26.1-33.2). original findings in a study with the same sample size is Risk was markedly elevated for fatal self-poisoning likely to yield P-values well above 0.05, however the upper whether classified as intentional, accidental or of 95% bound for the overall P-value that includes all undetermined intent. Risk of fatal self-poisoning by conditions is 1.5e-05, suggesting that the SNP is psychotropic medication was especially raised (IRR 93.7; associated with psychiatric disorders. 95% CI 62.5-140.5). Although incidence was higher among Conclusion: Since some proportion of findings in men for each mortality outcome examined, the relative risk psychiatric literature may be spurious, in this work, we versus individuals not admitted was higher for women. focused on variability of P-values in replication studies to Conclusion: The huge elevation in risk for fatal poisoning develop a better appreciation of their potential range. We indicates that enhanced post-discharge care and more hope that our method for construction of a P-value vigilant monitoring of prescribed medication are needed. prediction interval, along with the corresponding software, Closer liaison between inpatient services and community will promote the use of Bayesian modeling in psychological care could potentially decrease mortality risk following science. discharge. Understanding why persons discharged from inpatient psychiatric units are at such elevated risk for PP65│Suicide method and specific types of intentionally jumping to their deaths from high places fatal accidents and poisonings among requires further investigation. people discharged from inpatient PP66│Economic rationality in adolescents psychiatric services 1 1 1 with emerging mood disorders Florian Walter , Matthew J. Carr , Pearl L.H. Mok , 1 2 2,3 2,3 Angé Weinrabe , Hui-Kuan Chung , Agnieszka Sussie Antonsen , Carsten B. Pedersen , Jenny 3 1 1 1 Tymula , Ian B. Hickie Shaw , Roger T. Webb 1Centre for Mental Health and Safety, University of Manchester, 1Youth Mental Health Research, Brain and Mind Centre, Faculty Manchester, United Kingdom; 2Centre for Integrated Register- of Medicine, The University of Sydney, NSW, Australia; 2 based Research, CIRRAU, Aarhus University, Aarhus, Department of Psychology, New York University, New York, NY, Denmark; 3National Centre for Register-based Research, U.S.A.; 3Faculty of Economics, The University of Sydney, NSW, Business and Social Sciences, Aarhus University, Aarhus, Australia Denmark Anxious and depressed people are commonly Background: Patients discharged from inpatient characterized as irrational. However, in mental healthcare psychiatric care are at elevated risk for premature a clear definition of what constitutes being irrational is unnatural death. We investigated multiple specific causes missing. In this paper we used the definition of irrationality of unnatural death in a large national cohort with sufficient from economic theory and investigated in incentive- power to examine these rare outcomes comprehensively. compatible experiments involving choices over consumer Methods: We followed up a national cohort of 1,683,645 products whether indeed anxiety and depression are persons born in Denmark during 1967-1996 from 15th associated with irrational decision-making. At two-time birthday until death, emigration or December 31, 2011, points, separated by six to eight weeks, we measured thirty whichever came first. Using survival analysis techniques, adolescent participants’ irrationalities (as violations of the we estimated incidence rate ratios (IRRs) to compare risks Generalized Axiom of Revealed Preference) and their among discharged psychiatric patients versus persons not anxiety and depression levels (via widely used psychological self-report scales for youth disorders —

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Kessler Psychological Distress (K10), Quick Inventory of scenarios were further examined, using different prevalent Depressive Symptomology (QIDS-A17) and SPHERE-12). rates from the literature, as well as different cut-off scores We then tested whether differences in mood scores for depression. All alternative scenarios were also cost- between participants and changes in mood within effective. The results were sensitive to variables of quality participants correlate with economic rationality. We found adjusted life years for the depressed fathers, probabilities that in comparison with previously studied reference of remission in treatment and no treatment groups and groups that did not report suffering from mood disorders; start age and productivity losses. The probabilistic the degree of economic irrationality was higher in our sensitivity analysis resulted in a 70 percent probability of sample. Moreover, adolescents whose mood was worse the postnatal depression screening intervention being as assessed by K10 were more irrational. Our results may cost-effective. have implications for both diagnosis and treatment of mood Conclusion: The postpartum screening intervention for disorders. fathers could be cost-effective compared to no screening. Decision-making | rationality | depression | anxiety | Further research should be undertaken to confirm the emotion current findings and create stronger evidence for decision makers and health care institutions. PP67│Screening fathers in Sweden for postpartum depression is cost-effective PP68│Mental health support Swedish child Michael Wells, Michaela Modin Asper, Nino Hallen, health nurses provide to mothers and Magdalena Carlberg, Anna Månsdotter, Lene fathers: Is it equal? Lindberg Michael Wells, Lene Lindberg Karolinska Institutet, Stockholm, Sweden Karolinska Institutet, Stockholm, Sweden

Introduction: Postpartum depression begins after Introduction: The mental health status of a parent affects childbirth and is associated with negative outcomes for the child and family, and personal outcomes. Since nearly all family, as well as increased societal costs. Postpartum families in Sweden visit the child health centers, screening depression prevalence in Sweden ranges between 6-10 and supporting both parents could positively impact percent for fathers and 13-16 percent for mothers. multiple child and family outcomes. The aim of the current However, only mothers in Sweden are currently routinely study is to explore the extent to which nurses supported screened. The aim of this study was to determine if a mothers' and fathers' mental health. postpartum depression screening for fathers in Stockholm Methods: A total of 363 Stockholm County child health County could be cost effective. nurses completed a 23-item questionnaire focusing on the Methods: National Swedish databases were used to find support they provide to mothers and fathers regarding their registry data and a literature review was undertaken to mental health. The current study compared the extent to identify the model data inputs associated with postpartum which nurses were aware of mental health problems in new depression in Sweden. Carlberg et al.'s (In Press) study mothers and fathers, if they acknowledged those was used for its robust sample size (n = 3656), and problems, and if they provided supportive counseling for because they offered different treatment options. The that mental health problem. All items were scored on a Edinburgh Postnatal Depression Scale was used to Likert scale of 1 (never) to 5 (always). Descriptive and chi- measure depression symptoms, using a cut-off score of 12 square tests were used to assess the data. or more in the base case scenario. Different societal costs Results: Nurses ranged in years of experience from 0 to were accounted for, such as inpatient and outpatient costs, 40, with a mean of 11.4 years of experience. All but two antidepressant costs, productivity losses, and costs of nurses were female, and about half were 50 years or older. screening. The costs for both the intervention and control Around 86% of nurses stated that they were always or group were identical, except the costs of screening those almost always aware of a mental health problem in in the intervention group. The generated evidence was mothers, while 13% were always or almost always aware used to build a Markov model in TreeAge. One-way and in fathers. When nurses were aware of mental health probabilistic sensitivity analyses were performed to problems in new parents, 93% stated that they account for parameter uncertainties. Alternative scenario acknowledged maternal mental issues, while only 63% analyses were further undertaken to test the assumptions acknowledged paternal mental health issues. in the base case analysis. Furthermore, 73% of nurses provided additional mental Results: A postpartum screening for depression in fathers health support to mothers, while 38% of nurses provided is cost-effective in the base case scenario. Alternative additional mental health support to fathers. Therefore, on

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all items measured, nurses were aware of, acknowledged, PP70│Inter-relationships of mood, motor and provided support significantly more to mothers than to activity, and sleep using mobile fathers (p < .001). Conclusion: Nurses provided significantly more mental technologies health support to mothers than fathers. According to the Kailyn Witonsky1, Lihong Cui1, Joel Swendsen2, equity sensitivity construct, since mothers continue to Vadim Zipunnikov3, Kathleen Merikangas1 receive more mental health support than fathers, fathers 1 National Institute of Mental Health, Bethesda, USA; 2 University are more likely to not visit, resulting in receiving less of Bordeaux, PSL Research University, Bordeaux, France; 3 support for their mental health problems, which can Johns Hopkins Bloomberg School of Public Health, Baltimore, USA negatively impact child and family outcomes. In the child's best interest, nurses should consider screening fathers for There is increasing evidence regarding the complex daily mental health problems. interplay between regulatory systems like sleep, mood, and motor activity. However, traditional clinical ratings of PP69│Screening fathers for postnatal these systems that are retrospective and subjective depression: Both the Edinburgh postnatal oftentimes lack the complexity and external validity needed depression scale and Gotland male to comprehensively assess these systems in real time. The depression are needed use of mobile technology that employs real-time tracking devices offers a powerful method to begin examining these Michael Wells, Magdalena Carlberg, Maigun relationships. The goal of this study is 1) to examine the Edhborg, Lene Lindberg patterns of inter-relationships between motor activity, Karolinska Institutet, Stockholm, Sweden mood, and sleep based on mobile tracking; and 2) to evaluate whether these patterns differ among people with Introduction: Around 10% of fathers have major a history of mood disorders. depressive symptoms during the infants' first year of life. Data came from a nested community-based sample of 242 The Edinburgh Postnatal Depression Scale (EPDS) is adults and their first-degree relatives. DSM-IV mood widely used to screen fathers for symptoms of postnatal disorders were assessed via structured diagnostic depression. However, the EPDS may be limited in its ability interviews and mobile technology captured information to detect depressive symptoms in fathers. The Gotland daily for two weeks via two methods: (1) Minute-by-minute Male Depression Scale (GMDS) has been used on fathers, behavioral data from wrist actigraphy monitors and (2) but little research has compared these two screening tools. Electronic interviews 4x/day on a mobile device assessing This study aims to compare the results of using the EPDS activities, context, mood, and energy. The data was and GMDS when screening new Swedish fathers. transformed and centered by group mean and then Methods: When their infant was 3-6 months old, 3,656 modeled using generalized estimating equation models. fathers completed the EPDS and GMDS questionnaires Findings indicate that: (1) sleep duration had a bi- via mail. The study compared EPDS scores ≥10, and ≥12, directional, inverse association with motor activity; (2) in relation to GMDS score ≥13. Motor activity was inversely associated with mood, such Results: The EPDS found a prevalence of 13.3% at score that increased motor activity at one assessment was ≥10 and 8.1% at score ≥12, while the GMDS' prevalence associated with a decrease in sad mood in the subsequent rate was 8.6% at a score of ≥13. Associations with assessment; and (3) there was no direct association possible risk factors found: low income was associated between mood with either sleep duration nor disruption. with depressive symptoms in all groups, while those with These findings were more pronounced among people with three more children, with a lower education, born outside Bipolar Disorder. of Sweden were more likely to have depressive symptoms This data suggests that there are specific directional via EPDS, while the GMDS detected a higher risk for associations between sleep, activity, and mood. fathers who are single, living apart or widowed. Interventions targeted to increasing motor activity may be Conclusions: While there is overlap in detecting more effective in elevating mood than either modifying depressive symptoms in fathers, the EPDS and GMDS sleep or direct treatment of mood. This work also also independently detect additional fathers with demonstrates the power of dynamic phenotypes derived symptoms. Therefore, using only one scale risks missing from mobile technology in characterizing the inter- detecting some fathers with depressive symptoms. relationships of regulatory systems.

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PP71│Individual and municipal factors 1 Caetano R, Laranjeira R. A 'perfect storm' in developing associated with alcoholism in Brazil countries: economic growth and the alcohol industry. Addiction. 2006;101(2):149-52. Mauro Xavier1, Clarice Madruga2, Raul Caetano2,

Ilana Pinski2, Ronaldo Laranjeira2, Marcia Castro3 1Faculdade de Medicina da Universidade de São Paulo, São PP72│Population level impact of a systems- Paulo, Brazil; 2Escola Paulista de Medicina da Universidade based approach to reducing mental health- Federal de São Paulo, São Paulo, Brazil; 3Harvard School of related emergency department visits among Public Health, Boston, USA New York City children and adolescents Introduction and Methods: This study uses data from Carol Yoon, Sungwoo Lim, Sana Khan, Sze Yan Liu, LENAD-II (nationally representative). Between November Marivel Davila 2011 and March 2012, multistage cluster sampling was NYC Department of Health and Mental Hygiene, NYC, USA used to select 4,607 individuals (≥ 14 years old) in 174 municipalities. Although LENAD-II predates the Diagnostic Introduction: Mental health related emergency and Statistical Manual of Mental Disorders 5th Edition department (ED) visits among children and adolescents (DSM-5), it has a question about craving, which allowed have been increasing nationally since the 1990s, many of assessment of alcohol use disorder (AUD) that matched which originate from schools and are considered to be DSM-5 criteria. A missing data category was created for all nonurgent. Beginning in 2013, New York City (NYC) took individual level variables with missing values. The number a systems-based approach to reduce the numbers of of Family Health Strategy teams (public primary health nonurgent ED visits. This approach included programs that care) per 10,000 inhabitants, and of Psychosocial Care increase schools' capacities to respond to mental health Centers (PSCCs, public secondary mental health care) per problems and programs that serve boroughs to reduce 10,000 inhabitants in 2011 were obtained from the Ministry inappropriate ED presentations. We assessed the impact of Health. Gross Domestic Product per capta for 2011, Gini of this approach in reducing the number of NYC mental Index for 2010, and municipal population for 2011 were health-related ED visits among children and adolescents, obtained from the Brazilian Institute of Geography and 5 to 17 years, from 2006 to 2016. Statistics. Municipal level variables were dichotomized in Methods: Mental health ED use from 2006 to 2016 was above/below state average. Four multilevel logistic based on data collected from the NYC ED Syndromic regression models were built in Stata v.13, with Surveillance System, a near-real time dataset of municipality as group variable. anonymized patient-level chief complaint and Results: Table 1 shows the results of all models. The demographic data for nearly every NYC ED visit. The missing data categories for ethnicity and migratory status Joinpoint Regression Analysis Program, version 4.0.4, was were omitted in models 2 and 4 because they predict used to calculate trends by proportion of ED visits that failure perfectly (22 observations were dropped). Also, the were mental health-related for children (5 to 12 years) and missing data category for family income in models 2 and 4, adolescents (13 to 17 years). and for urbanicity in model 4 show significant association Results: Between 2006 and 2014, the annual proportion with AUD, indicating bias. Regardless of the model of NYC ED visits that were mental health related increased formulation, being male, younger, migrant, LGBT or having significantly (Annual Percent Change = 3.69%) among children were associated with higher odds of alcohol children 5 to 12 years, followed by a decreasing, non- consumption, while more education, religious affiliation, significant trend from 2014 to 2016. A similar pattern was being older or housewife with lower. observed among adolescents 13 to 17 years; the Conclusion: Results converge to current discussions proportion of mental health-related ED visits increased about the link between economic growth and expansion of significantly between 2006 and 2013 (Annual Percent the alcohol industry in developing countries, leading to Change = 8.66%), followed by a decreasing, non- increased alcohol availability1. They also suggest that the significant trend from 2013 to 2016. effect of municipal inequality on AUD translates through Conclusion: We explored the use of syndromic individual-level sociodemographic variables. In addition, surveillance data to evaluate the population-level impact of results underscore the importance of the PSCCs and point a systems-based response to mental health-related ED to specific groups that are at higher risk for AUD and, visits in NYC. We found a nonsignificant decrease in the therefore, can be the target of preventive measures. proportion of mental health-related ED visits in NYC after 2014 for children, approximately a year after implementation of various programs aimed at decreasing youth mental health-related ED visits. Although we cannot

Book of Abstracts 62

evaluate specific programs and/or policies that may have Results: Ozone exposure at baseline was significantly influenced findings, timing of the change in increasing associated (p<0.05) with increased anxious/depressive trend provides preliminary support for the effectiveness of symptoms, adjusting for multiple potential confounders system-based efforts. and other air pollutants. The estimated effect sizes (per interquartile increase of ozone by 5.40-5.60 ppb) were PP73│Longitudinal analysis of ambient air equivalent to the difference in anxious/depressed pollution and increased anxious/depressive symptoms between adolescents who are 1.5 years apart in age. These associations were primarily driven by symptoms of adolescents in Southern between-area differences, and to a less extent by changes California in ozone exposure estimates across time. No statistically Diana Younan1, Catherine Tuvblad2, Meredith significant associations were observed with the other Franklin1, Lianfa Li1, Jun Wu3, Fred Lurmann4, Kiros pollutants. Berhane1, Laura Baker1, Jiu-Chiuan Chen1 Conclusion: Our study provides the first longitudinal 1University of Southern California, Los Angeles, USA; 2Örebro evidence suggesting that long-term ozone exposure may University, Örebro, Sweden; 3University of California, Irvine, increase anxious/depressive symptoms in adolescents. Irvine, USA; 4Sonoma Technology, Inc., Petaluma, USA Future studies need to investigate the prenatal/early- childhood ozone exposure effect and whether the long- Introduction: Air pollution is the leading environmental term neurotoxicity extends to late life. threat to global public health. Experimental studies have Funding Sources: This research was supported by the shown prenatal and/or early-life exposures to ambient air National Institute of Environmental Health Sciences pollutants result in long-term changes in (NIEHS R21 ES022369 and F31 ES025080). Younan was anxious/depressed symptoms in adolescent and adult partly supported by NIEHS R01 ES025888, and her work mice. Although evidence suggests early-life exposure to was also supported by the Southern California ambient air pollution may increase anxious/depressed Environmental Health Sciences Center (5P30ES007048). symptoms of school-age children, epidemiologic findings The USC Twin Cohort Study is funded by the National were inconsistent and primarily based on cross-sectional Institute of Mental Health (NIMH R01 MH058354). analyses with no data on adolescents. Methods: We conducted a longitudinal study to examine PP74│The risk of antidiabetic drug whether the trajectories of anxious/depressed symptoms in adolescents were affected by ambient air pollution in prescriptions among antipsychotic drug Southern California. Participants (n=500) of the Risk users in Poland Factors for Antisocial Behavior study were examined in Pawel Zagozdzon 2000-2012 (aged 9-18 years) with repeated measures of Medical University of Gdansk, Gdansk, Poland anxious/depressed symptoms every ~2-3 years (up to 4 behavioral assessments) using the parent-reported Child Numerous studies have investigated the relationship Behavior Checklist. Based on prospectively-collected between antipsychotic drug use and the incidence of residential addresses, we estimated individual-level diabetes, but their results were not entirely consistent. Our monthly averages of 24-hour PM2.5 and ozone using study aimed to elucidate the association between generalized additive models, weekly NO2 using land-use antipsychotic drug use and the risk of antidiabetic drug use regression (LUR) models, and yearly freeway and non- within healthcare database. freeway NOx/NO2 using the CALINE4 dispersion model. Methods: We conducted a retrospective longitudinal These estimates were aggregated to represent long-term analysis involving 88 431 patients who were receiving an (1-, 2-, 3-year) exposures preceding the baseline antipsychotic medication between 2008 and 2012. We assessment. Multilevel mixed-effects models were used to identified all patients who were prescribed any antidiabetic examine the association between ambient air pollution drug. The study was based on the 2008-2012 prescription exposure and individual trajectories of anxious/depressed drug reimbursement data from the Polish National Health symptoms, adjusting for within-family/within-individual Fund in Gdansk. Cox proportional hazard was used to correlations and potential confounders (e.g., analyse time to first antidiabetic drug among those patients sociodemographics; self-perceived quality and contextual who were without antidiabetic medication at least three socioeconomic characteristics of neighborhood; months after first antipsychotic drug. greenspace; unban vs. non-urban; other spatial Results: There were 1 095 518 neuroleptic prescriptions covariates; maternal and early-life risk factors) during analysed period. Antidiabetic drugs were prescribed in 15% of patients receiving antipsychotics and this

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corresponds to 333 005 prescriptions for antidiabetic solving problems (p=0.031), poor relationships with drugs. There were 79 660 patients who were without mother-in-law (p=0.004), poor relationships with parents antidiabetic drugs for at least 3 months after first during own childhood (p=0.023). Depressed women had antipsychotic drug prescription. The incidence rate for higher frequency of cesarean section (p=0.002), previously antidiabetic medication use was 0.018 per patient-year. diagnosed depression (p=0.007) and employment outside Conclusions: These results suggest that antipsychotic of home (p=0.020). Notably, poor relationships with medications use is associated with increased risk and mother-in-law and lack of partner's support in household prevalence of antidiabetic medication use compared to duties remained significant predictors of PPD after general population. Although the study was based on adjusting for confounders (OR 2.04, 95% CI 1.019-4.097 administrative record linkage and therefore could not be and OR 2.24, 95% CI 1.108-4.526, respectively). adjusted for potential confounders, its results suggest that Conclusion: The estimated prevalence of PPD among greater attention should be paid to patients with women exceeds the reported average PPD prevalence in antipsychotics to prevent the occurrence of cardiovascular Western countries. Frequently unreported family risk- diseases associated with diabetes and metabolic factors, that are attributable to the Kazakh culture are syndrome. discovered, including relationships with partner and in- laws. Effective intervention strategies are necessary to PP75│Prevalence and sociocultural risk strengthen the psychological health of mothers in Astana factors of postpartum depression in Astana, and Kazakhstan as a whole, targeting not only mothers, but also social family relationship norms. Kazakhstan References: O'Hara, M. W., & Swain, A. M. (1996). Rates Zhansaya Zhanasbayeva1, Raushan Alibekova1, and risk of postpartum depression-a meta-analysis. Gauri Bapayeva2, Aigul Saparbekova2 International Review of Psychiatry, 8(1), 7-54. 1 Nazarbayev University School of Medicine, Astana, https://doi.org/10.3109/09540269609037816 Kazakhstan; 2 National Research Center for Maternal and Child Health, corporate fund “University Medical Center”, Astana, Kazakhstan PP76│Disrupting the 'Othering' of the mentally ill: The psychology of Introduction: Postpartum depression (PPD) is recognized neocolonialism and psychological liberation as the major public psychological health issue that affects of the mentally ill through biopolitical 13% of women at postnatal period worldwide (O'Hara and Swain, 1996). Currently, there is a lack of information frameworks in Ghana about the state of PPD in Kazakhstan, Central Asian Opemipo Akerele country with population of 17.8 million. To bridge this gap, Stanford University, Carson, USA PPD prevalence and risk factors among women in Astana, the capital of Kazakhstan, are evaluated. Mental health services, with my research focus on the most Methods: A consecutive sample of women who gave birth prevalent disorders: schizophrenia and depression, are within past 12 months were recruited in two major incredibly under-resourced. Ghana has just 18 practicing outpatient clinics of Astana, Republican Diagnostic Center psychiatrists and only three psychiatric hospitals for the and National Research Center for Maternal and Child entire country. Mental health services funding is often Health. Participants of this ongoing cross-sectional study disregarded compared to funding concerning infectious completed an anonymous self-reported questionnaire diseases or reproductive health. There are many collecting sociodemographic and medical data. Maternal misconceptions about mental illness; for example, the idea depression was assessed using the translated and that children of mental health staff often acquire mental adapted Kazakh and Russian versions of Edinburgh illness discourages providers from going into mental health Postnatal Depression Scale (EPDS). EPDS score ≥13 was care. Due to resource constraints and the stigma attached considered as PPD indicator. Potential risk-factors were to mental illness, the majority of the population suffering identified using bivariate tests and multivariate logistic from psychiatric conditions are not treated with modern regression. medicine like psychotherapy or medication; instead, they Results: 25% of 104 participants had EPDS score ≥13 are sent to spiritual churches or prayer camps where they (μ=9.48, σ=4.58). Women with PPD were more likely to are sometimes severely mistreated by being chained up have more than one child (p=0.029), insufficient relatives' (sometimes outside in poor weather conditions) or support in child care (p=0.013), inadequate partner's prevented from using adequate medical care. assistance in household duties (p=0.044) and support in Furthermore, the dearth of research in mental health

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contributes to insufficient understanding of how the asylum systems technological instruments for social and Ghanaian mental health system (comprised primarily of political control?" Through extensive interviewing, a psychiatric hospitals, the government, nonprofits, and nuanced perspective concerning orthodox and traditional faith-based healing in prayer camps and religious centers) medical systems and how they impact the Ghanaian may influence the social differentiation, or 'othering,' of the population's use of mental health services was gained. The Ghanaian mentally ill and impact Ghanaian mental health top 8 major issues identified that impact the use of mental care-seeking behavior or utilization of the Ghana mental health services are: Societal Stigma, Economic and hospital system. These 'othered' mentally ill are not Political Factors, Education, Transportation and 'normal' and are ostracized from the rest of their Infrastructure, Health System and Resources, Type of community. This research study will accomplish an Healthcare, Quantity of Mental Health Professionals, and analysis of how these institutions may influence the Culture and Spirituality. Ideas for improvements to these 'othering' of the Ghanaian mentally ill in the past and barriers are a decentralized mental health system, a present. The focus will be on the following research partnership between medical and traditional healing questions: "How do Ghanaian mental health institutions system, and awareness and education through the media. and their strategies influence the social 'othering' of the Ghanaian mentally ill? How does this not only impact the vulnerable population but also impact voluntary mental health care utilization and mental health care seeking behaviors in Ghanaian society? Are the mental health and

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Abstracts are published in the present Book of Abstracts as submitted by their authors. Missing presentations as per the Meeting Program were not submitted on time or have been cancelled.

Meeting Organizing Secretariat

ERASMUS Conferences Tours & Travel S.A. 1, Kolofontos & Evridikis street, 161 21 Athens, Greece Telephone: +30 210 7414700 | E-mail: [email protected] Website:www.wpaepi2018.org ; www.erasmus.gr

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Book of Abstracts 67